INTRODUCTION TO BEHAVIOR CHANGE COMMUNICATION (BCC)

Mon 27th Feb 2012

BCC
In buzz groups:
1. 2.

What is your understanding of BCC? How is BCC different from IEC?

IEC vs BCC

Information, Education and Communication (IEC)

IEC is a process of working with individuals, communities and societies to: - develop communication strategies to promote positive behaviors which are appropriate to their settings.

Behavior Change Communication (BCC)

BCC is a process of working with individuals, communities and societies to: - develop communication strategies to promote positive behaviors which are appropriate to their settings; AND - provide a supportive environment which will enable people to initiate and sustain positive behaviors.
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The change in BCC!!

Why is BCC different from other forms of information and communication programmes?

BCC seeks to understand peoples situations and concerns, provides appropriate knowledge and skills required to practice new behaviour BCC recognizes people as active rights holders rather than passive beneficiaries BCC promotes client-centred approach, BCC promotes informed choice and rights approach

BCC some associated terminologies

BCC is sometimes referred to by many names.

IEC IEC/BCC Health education Health promotion AIDS education Social Marketing

They share some common elements but have differ in scope. Most of them include attempts to change behavior through communication in different stages and methods Most new: SBC

THEORETICAL FRAMEWORK OF
BEHAVIOUR CHANGE

COMMON QUESTIONS How does behaviour change occur? Why do people behave the way they do? What can be done to support people change their behaviour in positive ways?

BCC is Theory-based
Theoretical principles for behavior change are the basis for the design of all BCC interventions that aim at influencing change and promoting sustained behavior change.

Purpose of Theory in BCC

To describe and identify where the problem is

To predict and understand motivational influences on behavior To identify how and where to target strategies for changing behavior

To explain virtually any human behavior

Search for modifiable factors

Framework of behavior change cont.

Every HIV prevention programme, however, is modelled in a way that tries to respond to these questions
There are various theories, which identify underlying principles and provide a guide on the essential elements that influence individuals to act in certain ways.
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Behavior Change Approach

Individual

behaviour theories focus on the

individual: they focus on an understanding of personal beliefs, perceptions and attitudes.

Interpersonal

behaviour theories see behaviour

as a relationship between the individual, his or her actions and the environment.

Some Behavior Change Models

The Stages of Change or Transtheoretical model Theory of Reasoned Action or Theory of Planned Behavior The Health Belief Model The Social Learning or Social Cognitive Theory Diffusion of Innovations

Two types of behavioral theories

1. Theories of behavioral prediction Address why people change behavior
2. Theories of behavioral change Explain how people change

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1. Theories of behavioral prediction Address why people change behavior Focus on internal and external factors that influence peoples behavior BCC programs use these to identify factors that influence behavior Help BCC programs understand the intended audiences perspective Some examples Health Belief Model, Theory of Reasoned Action, Social Cognitive Theory
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Health Belief Model

A psychological model that attempts to explain and predict health behaviours by focusing on the attitudes and beliefs of individuals.

Perceived threat 1. perceived susceptibility 2. perceived severity Perceived Benefits Perceived Barriers Cues to Action Self Efficacy
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Theory of Reasoned Action

(M. Fishbein and I. Ajzen)

TRA specifies that adoption of a behavior is a function of intent. It specifies that adoption of a behaviour is determined by a persons attitude (beliefs and expected values) towards performing the behaviour and by perceived social norms (importance and perception of others).

Emphasizes the effect of social influences on personal behaviour - Beliefs about the consequences of behaviour. The individual asks, What will happen to me if I take this action or try to do so - Perceived social norms: The individual asks, what do I believe others would do about the situation? What do I believe others would want me to do

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Social Learning Theory

(A. Bandura)
A theory which states that ones behaviour and cognition together will affect future behaviour.

In this model, behaviour, personal factors, and environmental influences all interact. An individuals ability to symbolize behaviour, to anticipate outcomes, to learn through observation, and to have confidence in performing the behaviour are all crucial.

People learn by: Observing what other people do Considering the consequences experienced by those people Rehearsing what might happen in their own lives if they followed the other people's behaviour
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8 important factors for theories of prediction

1. Intention to perform 2. Environmental constraints and barriers 3. Skills
4. Attitude 5. Perceived social (normative pressure) 6. Self image 7. Emotional reaction 8. Self-efficacy
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2. Theories of behavioral change

Focus on the stages people pass through as they change behavior BCC programs use these theories to identify the intended audiences current stage of behavior change This helps in the tailoring of approaches and messages Also helps programs to gauge how much change is possible and to set realistic objectives Examples include stages of change, diffusion of innovation

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Diffusion of Innovation
(Ryan and Gross, 1943)

Traces the process by which a new idea or practice is communicated through certain channels over time among members of a social system.

The model describes the factors that influence peoples thoughts and actions and the process of adopting a new technology or idea Knowledge ->persuasion ->decision -> Implementation -> confirm
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STAGES OF CHANGE THEORY

(J Prochaska & C DiClemente)

Also known as the Transtheoretical model An individual behaviour theory. Used to describe behaviour change common to health related actions e.g. smoking cessation weight control, stress
reduction.

Describes the achievement of successful behaviour change through a number of stages.

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Stages of behavior Change

Summary of Behavior change models

Are theoretical and conceptual approaches to explain health behaviour. Seek to explore methods that foster behaviour change. May be used to guide the development and evaluation of programmes

May be used to address behaviours at the individual, organizational and societal levels

Behavior change is a continuous process

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Not all individuals go through the same steps of the process in the same order, speed or time People at different steps require different messages and sometimes different approaches. It is important to know what stage the person is before beginning a communication process As knowledge and approval reaches high levels, BCC emphasis must shift to later steps
identifying cues for action maximizing access and quality of services identifying and removing barriers to change creating opportunities for increased peer advocacy

Percentage CSWs having knowledge, intent, trial and maintenance for use of condom- Bangladesh
40 35 30 25 20 15 10 5 0 Knowledge Intent Trial Maintenance 14.6 6.3 27.8 37.8

Knowledge= knows about use of condoms prevent STD; Intent=desire to use condom; Trial= tried condom at aleast once in last 24 hrs; Maintanence= used condom>50% of all last sexual encounter in last 24 hrs

Factors that influence our behaviour

n
n n n n

n
n

Values Perceptions Beliefs (cultural, religious) Attitudes Personal experiences Socialization Peer influence
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Four Important Factors

There are four important factors that we need to take into account when we are trying to decide the goal of BCC programs.
1.

If a person knows what he/she should do, it does NOT mean that he/she will do it.

2.

If a person wants to do a behavior, it does NOT mean that he/she will do it.
Many times we try to increase the level of FEAR that a person has in order to get him/her to do a preventive action. Many of the actions that people engage in that improve their health are NOT necessarily done for health reasons.
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3.

4.

Note!!
Behaviour

change does not occur in a

vacuum
Behaviour

change does not occur in a linear manner

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Effective BCC programs

Are a process rather than a product Rely on research Proven process Community involvement Develop relevant materials and messages Combine various communication channels Address both the individual and the society Developed with sustainability in mind

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So what should an effective BCC program do

1.

2.

3.

4.
5. 6. 7. 8.

Increase knowledge on the basic HIV/AIDS facts Stimulate community dialogue on the underlying risk factors Promote essential attitude change e.g.. perception of risk Reduce stigma and discrimination Create demand for information and services Advocate for policy changes Promote services for prevention, care and support Improve skills and sense of self efficacy

BCC Model

Source: FHI (2000)

Challenges in BCC programs

? What are some of the challenges you are facing in your BCC programs?

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Challenges

IEC vs BCC Integrating BCC programs into all programs BCC is a component of successful interventions. Must identify opportunities for improving the quality of communication components Limited/restricted training resources Environment (political and physical) Sustainability Scale-up / expanding the response Budgeting budget lines for production of materials but no provision is made for development process
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BCC alone is not enough

Social norms and public policies influence behavior change. A strategic shift must be also be attempted simultaneously. Behavior change communication is not a stand alone strategy. It has to be used in conjunction with other strategies such as STD treatment, condoms and creation of enabling environment BCC often complements and supports other prevention strategies and approaches

Thank you!

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