1. BEHAVIOUR CHANGE
COMMUNICTION
(BCC)
Paper Presented by: Innocent Daka (ZANIS)
UNFPA Journalists Training Workshop
Fringilla Lodge
Chisamba
July 2 to 6, 2012
1
2. OBJECTIVES
Provide definition for BCC
Know the six key stages of BCC
Understand Different Approaches/Channels to BCC
Understand Use of Mass Media & Alternative Media
Define and Differentiate BCC Objectives
Understand Audience Segmentation
Understand Message Development in BCC
3. DEFINITION
Behaviour Change Communication
BCC is an interactive process that works through individuals, families
and communities and delivered through different communication
channels to promote positive health behaviours and support an
environment that enables the community to maintain positive health
behaviours taken on.
•BCC Moves People From Awareness to Action!
•It is about identifying the causes and barriers to behaviour change and
overcoming the barriers.
•It is about understanding the communities, contexts and environments
in which behaviours occur.
4. BCC Explained...
BCC being interactive means examines the environment and
identifies different health issues that affect different segmented
groups or stakeholders--people who are affected by different
health issues.
These stakeholders include individuals’ families and communities.
The communication messages that are developed and delivered
through different channels are designed, planned and
implemented to meet the needs of the different groups
There is ownership of the BCC programmes by the community.
5. BCC Explained
BCC has evolved from Information, Education and
Communication programmes that have formed part of health
communication for a long time.
While IEC programmes have been focused at imparting
information and improving health knowledge, they did not have
the depth of moving people to action.
Therefore BCC does not just end at creating awareness.
It also seeks to motivate people to believe that change in behaviour
results in gaining health benefits while increasing their sense of
control over their own health behaviour choices.
6. BCC Explained
The success of BCC messages and programmes aims at providing
both information and appeals to individuals emotions.
7. Key Elements & Stages
Key Elements & Stages (BCC MODEL)
1. Awareness
2. Knowledge
3. Attitude change (Approval, Intention)
4. Practice of new behaviour
5. Reinforcement of behaviour
6. Advocacy (telling and persuading others to also adopt
new behaviour)
8. Key Elements & Stages
Awareness:
One is aware of the existence of a threat in terms of HIV being real
Knowledge:
One first learns about how HIV is transmitted or (knowing correct
use of condoms)
Recalls messages on use of condoms and understands meaning of the
messages
Can name the strategies of safe sex and practices
9. Key Elements & Stages
Attitude Change
Approval:
•One then approves of the new behaviour (safe sex and condom
use Strategies)
•Responds favourably to safe sex (condom use) messages
•Discusses condom use with peers or others
(professional, colleagues, family and friends)
•Thinks professional colleagues, family, friends and community
approves of condom use practices.
10. Key Elements & Stages
Intention:
•One then believes this behaviour is beneficial to them and
intends to adopt it.
•Recognizes that safe sex (condom) strategies can meet a
personal need
•Intends to adopt safe sex (condom use) practices
Practice:
•One then attempts new behaviour and continues to practice.
(Practices proposed under each strategy in safe sex (condom
use)
11. Key Elements & Stages
Advocacy
•One can then promote the new behaviour through their social
or professional networks as a satisfied practitioner.
•Experiences and acknowledges personal benefits of adopting
behaviours that enhance safe sex (condom use).
12. Importance of the Elements
The mentioned elements are crucial to the success of completing
these steps:
The rational element, based on knowledge: People need to know
the basic facts about a health issue.
Example: how the virus is and is not transmitted, how likely they
are to become infected, and what they can do to avoid infection.
People must be made to feel that the threat posed by the health problem is
real and serious. In other words, both perceived susceptibility and
perceived severity of the threat must be high
13. Importance of the Elements
The emotional element, based on the intensity of attitudes or feelings:
Individuals need to feel the seriousness of being vulnerable to the virus.
This makes them develop an emotional commitment to the behaviours
needed to avoid it.
“In a heightened state of awareness because of the fear, people must
believe that they have the capability to take action that will avert the
threat. At this stage, people’s confidence in their ability to act—their
self-efficacy—and their belief about the effectiveness of the act—also
known as the response efficacy—must both be high”
14. Importance of the elements
The practical element, based on personal skills in a new
behaviour: People need to be competent in practicing the new
behaviour and be confident in their ability to do so.
They need a sense of self-efficacy to adopt
new, health-protective behaviours.
―When high levels of existing threat are combined with high levels of
efficacy, then people invoke a “danger-control strategy,” which prompts
them to take meaningful steps that will minimize the threat, including
taking precautions or preventive measures”
15. Importance of the elements
The interpersonal element, or social networks: People
need to associate with and be supported by their significant
others (such as family members and peer groups) whose
knowledge, emotions and skills can reinforce healthy
behaviour changes.
“There is the belief that people learn to act by observing the actions
of others, observing what happens as a result of those
actions, evaluating the results in relation to their own lives, and
then rehearsing and attempting to reproduce those actions
themselves. Social learning appreciates the use of role models”
16. Importance of the elements
The structural element, or the social, economic and legal
context in which behaviour takes place: People need to have
access to necessary supplies and services (such as voluntary
counselling and testing facilities), and to live in an environment
where safer behaviours are accepted and promoted while risky
behaviours are discouraged.
17. Importance of elements
The Change Agent element: the person or group that has adopted
health behaviour begin to encourage others to adopt the new
behaviour. They also start lobbying for structures that are supportive
to the health behaviour
19. Different Approaches/Channels
The understanding of different approaches/communication
channels is important to BCC because it determines how best to
reach the intended audience with the messages.
Individual Approaches
BCC on a one-to-one basis is important in the prevention both
secondary and tertiary prevention of the disease. In secondary
prevention it can reverse the early symptoms of the disease while
in tertiary prevention it seeks to slow the progress of the disease
which already exists.
20. Different Approaches/Channels
The one-on-one or individually focused methods are useful in:
•Home based care and support interventions
•Counselling and testing for sexually transmitted diseases—
HIV/AIDS
•Peer education, reaching out to audiences that may be hard to
reach
BCC on a one-to-one basis is important in the prevention of both
secondary and tertiary prevention of the disease.
In secondary prevention it can reverse the early symptoms of the
disease while in tertiary prevention it seeks to slow the progress of
the disease which already exists.
21. Different Approaches/ Channels
Group Methods
Group methods of Behaviour Change Communication are used
widely and offer an intermediary approach between one-to-one
approaches and wider community approaches.
Under this method groups can vary. The methods used are
educational or informative.
These include: Lectures, seminars, workshops and Conferences,
Active participation is part of these methods. Another method used
is Experiential, which include skills training, behaviour
modification, inquiry learning/problem solving, simulation, role
play and self-help groups.
22. Different Approaches/ Channels
Group Methods
Group Methods have shown to have a role in:
Assisting individuals to gain knowledge and change attitudes and
behaviour
Providing a supportive setting for people who may share a common
goal (such as a group of people attending ante natal clinic)
Assisting members of a community or organization to improve their
ability in approaching their own health problems or getting them
empowered to facilitate change within their community or organization
23. Different Approaches/ Channels
Community Approaches
Community based approaches to BCC can potentially have a greater
impact on a larger amount of people. One of the principles of BCC is
work with individuals, families and communities to support an
environment that enables the community to maintain positive
health behaviours take on.
BCC works through concrete and effective community action in
setting priorities, making decisions, planning strategies and
implementing them to achieve better health.
By developing this principle some major changes can potentially be
made at a community level as a result of community based BCC
programs.
24. Different Approaches/ Channels
Community Approaches
Community –Based Formats include:
Media—local newspapers, radio stations, bulletin boards, posters
Activities—Health fairs, dramas, concerts rallies, parades, sports
events, community meetings
Mobilisation—a participatory approach of process of
communities identifying and taking action on shared concerns
25. Different Approaches/ Channels
Mass media approaches
In BCC, mass media will be effectively used by knowing the strengths
and weaknesses of the different methods.
The mass-media methods include
Television
Radio
Newspapers
Magazines
Outdoor/transit publicity
Internet
26. Approaches/Channels
Frequency and Reach are important terms in planning use of this
approach.
Frequency—the average number of times that one person is exposed
to a message
Reach—the number or percentage of members of the target
audience that will be exposed to the message.
27. Different Approaches/ Channels
Advantages & Disadvantages
Interpersonal
Some Advantages:
Most credible source
Most participatory
Highly effective
Some Disadvantages
Difficult to control messages
Requires training
Costly to scale up
Takes time to build reach
28. Different Approaches/ Channels
Advantages & Disadvantages
Community
Some Advantages
Participatory
May be more credible than mass media
Low cost
Encourages sustainability of effort
Some Disadvantages
Costly to scale up
Low reach beyond immediate community
Low Frequency
29. Different Approaches/ Channels
Advantages & Disadvantages
Radio
Some Advantages
Has wide reach in both urban and rural areas
Less expensive
Does not require a literate audience
Cost efficient
Messages can be repeated a number of times in a day
Some Disadvantages
Costly to build reach when many different stations cover area
No visuals
Can be interactive with audience
Fragmented
30. Different Approaches/ Channels
Advantages & Disadvantages
Newspapers
Some Advantages
Wide circulation—people can share a copy
Timely
Message length
People can clip and save news articles
Can reach influential people—policy makers
Some Disadvantages
Requires literate audience
Bias against visual impaired
Poor photo reproduction
May be expensive to some people
31. Approaches/Channel
Advantages and Disadvantages
Outdoor/Transit
Some Advantages
Good for awareness building
High Traffic areas
Brief message
Reinforces other media messages
Can reach influential people—policy makers
Some Disadvantages
Limited time of exposure
Limited message content
It is not durable
32. Selecting Communication
Channels and Media Mix
If you want a message to reach as many different people as possible
in the targeted audience, the channel mix will be based on reach
type—TV, Radio, well attended Community Event
If you intend to communicate a gradual message that will create
awareness over a period of time, the media that is affordable enough
to increase the frequency of the message is ideal. Radio,
Interpersonal Communication and print fall in this category.
Sometimes it is ideal to mix both reach and frequency media to get
the optimum outcome of the BCC activity
34. Audience Segmentation
Segmenting target populations
Assess the target population, understand its psychosocial and
demographic characteristics.
This enables targeting groups specifically to their interests and
influencing factors when designing interventions
Psychosocial characteristics include knowledge, attitudes and practices.
Demographic characteristics are represented by age, place of residence or
economic activity, place of birth, ethnicity and beliefs.
Others considered are structural factors and settings like workplace, risk
settings and border settings.
Example, if truck drivers are target population, border points, lay-by
villages and brothels constitute risk settings.
35. Audience Segmentation
The target population is segmented into three parts as follows:
Primary Target Audience:
Secondary Target Audience:
Tertiary Target Audience:
Primary Target Audience
This is the group of people that you are hoping will change in some way as a
result of the BCC program.
Example BCC for safe motherhood primary target will be pregnant women.
For reduction of HIV transmission in the transport sector, the primary target
population could be truck drivers, because they are away from home for
long periods of time and more likely to engage in risky behaviour.
36. Audience Segmentation
Secondary Target Audience
This is the people who have significant influence on the primary
target audience.
Example: for expecting mothers early attendance of antenatal, the
target may be Mother in Laws, husbands and TBA’s.
For the truck drivers, the wives and girlfriends of men who
frequent sex workers might fall into this category. There are often
several secondary target populations around one primary target
group, requiring different communication approaches and messages.
37. Audience Segmentation
Tertiary Target Audience
These are the people that wield significant power to assist you in
your program.
Example, these are people who may be able to influence policy and
funding for resources that will support your intervention.
Examples of tertiary target audiences may be Community leaders
or traditional leaders, ministry of health officials, and NGO’s.
“After identifying the targets an assessment of the groups segmented is
done so that stakeholders are fully aware of the realities of the targets. This
ensures that when the BCC programme is developed the messages, themes
and channels resonate with the target group”.
38. Defining BCC Objectives
BCC objectives are looked at from two levels.
First, there is Behaviour change objectives
These answer questions about the health behaviour that target group
must adopt. They are derived from programme objectives.
For Fish mongers at higher risk of STIs and HIV the behaviour you
want adopted include
1. Reduction in number of sexual partners
2. Use of STI and HIV services
3. Consistent use of condoms
39. Defining BCC Objectives
BCC Objectives should be SMART:
Specific
Measurable
Achievable
Relevant and
Time-based
40. Defining BCC objectives
Second, there is Behaviour change communication objectives:
These objectives are developed from behaviour change objectives. They
answer questions about what the communication messages will do to
support the adoption of the behaviour by the target group
Examples:
1. Increase self risk assessment
2. Increase confidence in condom use
3. Increase demand for VCT and STI testing services
4. Increase knowledge and enhance positive attitude about services
41. BCC objectives
BCC Objectives must result in the following
Relating to the behaviour change model, media personnel working on
BCC programme or undertaking BCC activities should ensure their
BCC objectives have the corresponding outcomes:
Awareness: results in increased awareness about the threat of a health
problem or threat e.g. HIV/AIDS, resulting in increased demand for
information about HIV and AIDS. (Target must be asking ask for
information about HIV and AIDS.)
Knowledge: Increased knowledge about HIV and AIDS. (Target group
will have correct knowledge of modes of transmission of HIV and
AIDS.)
42. BCC objectives
BCC Objectives must result in the following
Attitude Change: Increased self-risk assessment. (Sexually active target
audience with multiple partners realise if they do not adopt safer sex
they feel at increased risk of contracting HIV)
Practice: Increased demand for information on STIs. (Miners or truck
drivers will ask for more information on STIs).
Reinforcement of Behaviour: Increased demand for services. (Sex
workers will demand VCT services.)
Advocacy: Encouraging others to take on positive health behaviour
Take each target population’s needs and situation into consideration, along
with the initiatives that answer those needs
43. Developing Messages
BCC messages must support your objectives
Examples:
1. Reduce number of sexual partners
2. Use STI/HIV services
3. Use condoms consistently
BCC messages have two components they intend to meet
1. Desired behaviour
2. Key benefit
One must be able to perceive a benefit for adopting a health behaviour.
Example: If I stick to one sexual partner, I will protect myself and my
family from HIV/AIDS, I will save money and I will be seen to be
responsible.
44. Sample Messages
MESSAGES FOR YOUNG PEOPLE
1. YOUNG PEOPLE NEED YOUR SUPPORT TO PROTECT THEMSELVES
FROM HIV/AIDS
2. YOUR RIGHTS TO REPRODUCTIVE HEALTH SERVICES ARE
YOUNG PEOPLE’S RIGHTS TOO
3. PREVENT ABORTIONS, SUPPORT YOUNG PEOPLE TO ACCESS
REPRODUCTIVE HEALTH SERVICES
4. CONDOMS CAN PREVENT UNWANTED PREGNANCIES
5. PROTECT YOURSELF FROM HIV USE CONDOMS EVERY TIME YOU
HAVE SEX
45. Sample Messages
MESSAGES FOR ANTENATAL/POSTNATAL ATTENDANCE
1. MEN ACCOMPANY YOUR PARTNERS TO ANTENATAL
2. MEN SUPPORT YOUR PARTNERS ATTEND ANTENATAL
3. ALL ANTENATAL VISITS ARE IMPORTANT WHEN PREGNANT
PROTECT YOUR LIFE AND THAT OF THE BABY
4. THE FIRST DAY I KNEW I WAS PREGNANT I MADE MY FIRST VISIT
TO ANTENATAL
5. VISIT ANTENATAL CLINIC AT LEAST FOUR TIMES DURING
PREGNANCY
6. DELIVER AT A HEALTH FACILITY PROTECT YOUR LIFE AND
THAT OF YOUR BABY
46. Sample Messages
3. I CARE FOR MY FAMILY I TESTED FOR HIV
4. PROTECT YOUR UNBORN BABY FROM HIV GO WITH YOUR
PARTNER FOR HIV COUNSELLING AND TESTING
3. FATHERHOOD IS A RESPONSIBILITY FEW CHILDREN ARE EASY
TO SUPPORT USE FAMILY PLANNING
47. Sample Messages
MESSAGES FOR HIV/AIDS PREVENTION
1. GO FOR VCT KNOW YOUR HIV/AIDS STATUS PROTECT THE
UNBORN CHILD
2. KNOW YOUR HIV STATUS USE A CONDOM AND PROTECT YOUR
WANTED BABY
48. Seven Characteristics of Effective Messages
Cater to the Heart and the Head (messages must appeal to the
emotions to make people think seriously about the problem)
Create trust; (People trust what makes sense to them. Messages
must be believable and consistent with reality)
Call for action (Purpose of messages is to change people’s
behaviour. A message must call to action
.
49. Seven Characteristics of Effective Messages
Command Attention (Effective messages must stand out and get
noticed)
Are Clearly Stated (Keep It Short and Simple. Clear messages
have an impact)
Communicate a Benefit (Messages that communicate a benefit
have a greater chance to appeal to people)
Are Consistently Repeated (Credibility is built when messages
are repeated over time)
50. Seven Characteristics of Effective Messages
Cater to the Heart and the Head (messages must appeal to the
emotions to make people think seriously about the problem)
Create trust; (People trust what makes sense to them. Messages
must be believable and consistent with reality)
Call for action (Purpose of messages is to change people’s
behaviour. A message must call to action
51. Developing communication products
Development of specific communication support materials should be
based on decisions made about channels and activities. They can
include:
Print news and feature articles
Print materials to support health workers on specific care issues
Television spots for general broadcast
Promotional materials about the project, for advocacy
Scripts for theatre and street theatre
Radio or television drama (soap opera)
52. What to remember!
Knowledge change: an increase in knowledge e.g. among targeted
youth on modes of transmission of STIs such as HIV
Attitude change: an increase in perception of personal risk or a
change in authorities’ attitudes toward promoting condoms to
youth
Environmental change: a decrease in conditions that compel
women not to use Family Planning Products or an increase in
acceptance of messages about condom e.g. In institutions preaching
fidelity
.