Q: 3: Theories of change

Individual Level
1. Health Belief Model. A psychological model that attempts to explain and
predict health behaviors by focusing on attitudes and beliefs of individuals.
Conceptual framework of health behavior stating that health behavior is a
function of both knowledge and motivation.
Two major factors influence the likelihood that a person will adopt a
recommended preventive health action. First they must feel personally
threatened by the disease 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”

2. Stages of Change Model (Trans-theoretical Model)

Model evolved out of studies comparing the experiences of smokers who
quit on their own with those of smokers receiving professional treatment.
Basic premise: Behavior change is a process, not an event.As a person
attempts to change a behavior, he or she moves through five stages:
Precontemplation, Contemplation, Preparation, Action, and Maintenance
3. Theory of Planned Behavior (TPB)
The TPB and the associated Theory of Reasoned Action (TRA) explore the
relationship between behavior and beliefs, attitudes, and intentions. Both
the TPB and the TRA assume behavioral intention is the most important
determinant of behavior. Behavioral intention is influenced by a person’s
attitude toward performing a behavior, and by beliefs about whether
individuals who are important to the person approve or disapprove of the
behavior. The TPB differs from the TRA in that it includes one additional
construct, i.e. perceived behavioral control.
4. Precaution Adoption Process Model (PAPM)
The Precaution Adoption Process Model (PAPM) is a relatively new model
that has been applied to an increasing number of health behaviors. This
specifies seven distinct stages from lack of awareness to adoption and/or
maintenance of a behavior. In the first stage of the PAPM, an individual may
be completely unaware of a hazard (e.g. link between unprotected sex and
HIV)
2: Interpersonal Level
The individuals exist within, and are influenced by, a social environment.
Opinions, thoughts, behavior, advice and support of the people surrounding
an individual influence his feelings and behavior and vice versa. The social
environment includes family members, coworkers, friends, health
professionals, and others. The social environment also has impact on health.
Social Cognitive Theory (SCT) describes a dynamic, ongoing process in which
personal factors, environmental factors, and human behavior exert
influence upon each other.
5. Social Cognitive Theory (SCT)
Many theories focus at the interpersonal level, but SCT is one of the most
frequently used and robust health behavior theories.It explores the
reciprocal interactions of people and their environments, and the
psychosocial determinants of health behavior.One of the key concepts in
SCT is the environmental variable: observational learning. Social Cognitive
Theory (SCT) describes a dynamic, ongoing process in which personal
factors, environmental factors, and human behavior exert influence upon
each other.
Processes governing observational learning include:
Attention—gaining and maintaining attention
Retention—being remembered
Reproduction—reproducing the observed behavior
Motivation—being stimulated to produce the behavior
Three main factors affect the likelihood that a person will change a health
behavior:(1) self-efficacy, (2) goals, (3) outcome expectancies.

Q:6: Communication Objectives

Endeavor is an objective. These are the element which together achieve the
goal. Objectives are meant to be realistic targets for the program or project.
Objectives are written in an active tense and use strong verbs like plan,
write, conduct, produce, etc. rather than learn, understand, feel.
Communication Objectives
Definition: Communication Objectives are the specific communication
outcomes in support of the overall goal. Objectives should be attainable,
measurable, and time specific
Types of Health Communication Objectives
Process. Outcome. Impact.
Process Objectives
Everyday tasks that propel the mission of a program. Activities or process
objectives are fueled by inputs or resources. Describe the number or
duration of specific communication activities. Most commonly tracked by
using forms such as time lines, daily activity logs, or field notes. Logically
lead to Outcome Objectives
Outcome Objectives
Statement of the amount of change expected for a specified population
within a given time frame. Identify a health communication effort's
intermediate aims. Generally describe planned changes in knowledge,
attitudes, or behaviors of those targeted through communication efforts.
Impact Objectives
• Ultimate goal any program hopes to achieve.
• Focus on the long-range effects on health status indicators.
SMART Objectives
Specific
Objectives should specify what they need to achieve. The objective must be
straight forwards and emphasize action and the required outcome. Specific
means that the objective is concrete, detailed, focused and well defined.
Measurable
You should be able to measure whether you are meeting the objectives or
not. Means that the measurement source is identified and we are able to
track the actions as we progress towards the objective.

Achievable
Objective or expectation of what will be accomplished must be realistic
given the market conditions, time period, resources allocated. If the
objective is too far in the future, you’ll find it difficult to keep motivated and
to strive to attain it. Objectives need to stretch you, but not so far that you
become frustrated and lose motivation. Objective needs to be attainable by
you based on the skills you have and the constraints imposed.
Realistic
Realistic means that you have the resources to get it done. Achievement of
an objective requires resources, such as, skills, money, equipment, etc. to
the task required to achieve the objective. Your objective is probably
realistic if you truly believe that it can be accomplished.
Time-framed
Stating clearly when the objective will be achieved. Time-bound means
setting deadlines for the achievement of the objective. Deadlines need to
be both achievable and realistic.
Steps in Setting Communication Objectives
Step-1: Setting the behavior change that will meet the audience’s health
needs.
Step-2: Setting how much behavior will change.
Step-3: Setting time frame within which the expected change will occur.
Step-4: Linking behavior change to program objectives.
Step-5: Identifying indicators to track progress.

Q: 7: 1: Communication Approaches
• Communication is described in three different ways:
Intrapersonal, Interpersonal and Mass communication
Intrapersonal communication describes those methods of
communication which take place within a single person .Essentially it is
the thoughts and ‘talking’ you do inside your head. Intrapersonal
communication takes place within a single person.
Self-awareness: how a person sees him or herself involves three factors:
beliefs, values and attitudes.
Perception is about creating an understanding of both oneself and one’s
world.
Expectations are future-oriented messages dealing with long-term roles,
sometimes called ‘life scripts’.
Interpersonal communication
Is the type of communication that involves direct interaction between two
or more people or within groups. This form of communication can be face-
to-face, two-way, verbal or non-verbal interaction. Includes the sharing of
information and feelings between individuals or groups. The purposes of
interpersonal communication are to influence, help, discover and share.
Main benefits are the transfer of knowledge and assisting changes in
attitudes and behavior. Source to the receiver and vice versa.
Mass communication
Is a means of transmitting messages to a large segment of a population.
Electronic and print media are commonly used for this. The word ‘media’
refers not only to broadcast media (radio, internet and TV) but also to print
media (newspapers, magazines, leaflets and wall posters). Effects of mass
communication are the increased knowledge or awareness of an issue,
potential influence on behaviors at the early stages, communicate new ideas
to opinion leaders. Accuracy and plausibility. Lack of feedback.

Q: 7:2 Policy Development

A Policy is a plan, course of action, or set of regulations adopted by a
government, business, or an institution, designed to influence and
determine decisions or procedures. Policies serve as guides to action on
an issue by specifying expectations and regulations.
Step-1: Identifying the Problem. Describing the problem -
understand the nature of the problem. Analyzing the problem – find
out why the problem exists in the first place and who is affected by it.
Identifying and understanding stakeholders - Determining the
individuals and groups with an interest or stake in the problem or issue
under consideration.
Step-2: Assess Readiness for Policy Development. Before reaching a
decision to work towards establishing a policy, it is vital to assess. The
amount of community support you have to address your problem and
proceed with policy. The level of capacity to develop and implement
policy that exists within your organization and the broader community.
The level of community readiness to embrace policy as a solution to the
identified problem.
Step-3: Develop Goals, Objectives, & Policy Options. Objectives
can be viewed as directions or building blocks towards the
achievement of policy goals. Choosing a policy option. Generate a
list of policy options. Assess all policy options to determine fit with
goals & objectives.
Step-4: Identify Decision Makers & Influencers. Decide which
decision makers will be the focus of your support-building efforts.
Choosing the wrong people can waste resources & may even
jeopardize future strategies if you approach people at the wrong
level, or wrong time. Consider starting with someone lower on the
hierarchy rather than heading straight for the top.
Step-5: Build Support for the Policy
Gaining the support of both the stakeholder groups affected by a
policy and the decision makers responsible for implementing a
policy is critical. Without this support, a policy will not succeed. To
build support for a policy, health promoters can choose from a
range of persuasion strategies.
Step-6: Write &/or Revise the Policy. Healthy policies vary in
scope. Micro-level. Macro-level .Define the specific logistical &
legal details about a policy. The precise wording of a policy often
dictates whether or not it is passed.
Step-7: Implement the Policy. Ensure that all pre-requisites are in
place for policy implementation & then implement the policy.
Many policies have been retracted upon realizing that
implementation is impractical, too costly, too controversial or
progress toward the ultimate goal cannot be demonstrated.
Step-8: Evaluate & Monitor the Policy. Evaluation is the systematic
gathering, analysis and reporting of data about a policy to assist in
decision making. A thorough evaluation will help to collect
evidence on the effectiveness of a policy. Be accountable to the
stakeholders who supported the development and implementation
of the policy; and identify ways of improving a policy by
determining what works what doesn’t work and why. Process
evaluation monitors the implementation of your policy.
Outcome evaluation assess the results or impacts of a policy, both
intended and unintended, to determine whether or not the policy
made a difference
Q: 2: Tools for Communication
Communication tools are tactics that help to disseminate messages
and information to the media and target audiences. Channels
enable to reach the audience, while tools are what you use on
those channels. For example, television and radio are mass media
channels, while advertising and publicity are tools. Challenge is to
choose the best combination of tools to follow the strategic
approach and achieve the objectives.
Tools and tactics used to conduct messages through the channels
are: Advocacy, Advertising, Promotion, Interpersonal
communication (IPC) enhancement, Events promotion and
sponsorship, Community participation and mobilization, Publicity,
Entertainment.

Advocacy
Comprises a set of tools used to create shift in public opinion and
mobilize necessary resources and forces to support an issue, policy, or
constituency. Health advocates can influence governments,
organizations, and individuals on health matters.
Media Advocacy - Bringing about policy changes by using the media to
put pressure on policy makers.
Advantages: Builds supports among policy makers. Can build
coalition at grassroots level. Creates a positive environment.
Counters opposition.
Disadvantages: Limited in reach. Requires very specific skills.
Requires a knowledge of system and contacts,
Advertising :
Comprises a set of tools to inform and persuade in a controlled
setting through paid media, such as television, radio, billboards,
newspapers, and magazines.
Advantages: Ability to control message, content, media,
placement, timing and length of message.
Disadvantages: Initially expensive, although cost effective the long
run. Needs to use an advertising agency. Limited space. Less
credible.
Promotion
Encompasses a set of tools for providing added incentives to
encourage the audience to think favorably about a desired
behavior or to take some intermediate action that will lead toward
practice of the desired behavior.
Advantages: High response rate, activates audience, produces
action.
Disadvantages: Action is immediate but usually short term. Can be
expensive
Interpersonal communication (IPC) Enhancement
Consists of a set of tools that can enhance personal interaction
between clients and providers, including discussions within and
outside the clinic.
Advantages: Reaches the audience at individual level. Two way
communication. Reinforces behavior at providers setting. Builds
provider or counselor and client relationships. Lends itself to
effective feedback process
Disadvantages: If a provider or peer counselor fails to deliver on
his/her promise, the audience may be discouraged from return visits.
Events promotion and sponsorship. Developing and/or sponsoring
events for the purpose of calling attention to and promoting a desired
behavior, such as a news conference, celebrity appearance, grand
opening, parade, concert, award presentation, research presentation,
or sporting event.
Advantages: Generates publicity and goodwill.
Disadvantages: Short term, can be costly. Labor intensive

Community participation and mobilization

Consists of a set of tools for helping a community to actively support
and facilitate the adoption of a desired behavior. Inviting and allowing
the community to participate in learning and the provision of services
related to health care and health outcomes,
Advantages: Involves and engages the community as a whole.
Supports collective and individual behavior. Helps change
community norms.
Disadvantages: Time intensive. Takes a long time to scale up.
Communities may not always be homogeneous
Publicity
Use of nonpaid media communication to help build audience
awareness and positively affect attitudes towards the desired
practices.
Advantages: Provides an objective more credible source.
Generates awareness quickly and inexpensively. Enhances
advertising campaign.
Disadvantages: Lack of control of messages and media placement.
Can take time to foster media relationships.
Entertainment
A form of health communication in which educational content and
information is intentionally incorporated into a less formal program
format such as the use of songs, comics, skits, and movies, in an effort
to promote health.TV or radio programs, folk dramas, songs and games
that provide entertainment interspersed with educational messages
Advantages: Audiences are very receptive, Program content can be
engaging. Messages can be persuasive.
Disadvantages: Can be costly to produce. Requires careful design