Communication-for-Behavioral-Impact: An Integrated Model for Health and Social Change

Everold Hosein
Will Parks
Renata Schiavo
Publication Date
November 1, 2009

Published by Jossey-Bass, an imprint of Wiley, this book chapter offers a synopsis of the Communication-for-Behavioural-Impact (COMBI) approach, which is an international model and planning framework for strategic communication and social mobilisation that the World Health Organization (WHO) and its partners have been applying in more than 50 countries, reaching a minimum of 100 million people worldwide. The COMBI approach intends for practitioners to absorb and apply lessons learned, good practices, and theoretical assumptions from a variety of disciplines in an effort to improve the reach and effectiveness of interventions that seek to promote health behaviour and social change. COMBI's key planning mantras are: "First: Do nothing - produce no T-shirt, no posters, no leaflets, no videos, until you have set out clear, precise, specific behavioral objectives. Second: do nothing until you have successfully undertaken a situational market analysis in relation to preliminary behavioural objectives."

Following an introduction, the authors refer the reader to many publications that have explored the COMBI approach in more detail - its roots, its incorporation of principles and lessons learned from the private sector, the 10-step planning methodology that structures it (see Figure 18.2, "Key Steps in Designing a COMBI Plan", on page 545 of the chapter), and the evaluations that have been carried out to document COMBI's effectiveness. In doing so, they mention that COMBI's theoretical foundation and 10-steps planning methodology have "progressively matured from work on integrated marketing communication (a planning concept 'that recognizes the added value of a comprehensive plan that evaluates the strategic roles of a variety of communication disciplines and combines these disciplines to provide clarity, consistency and maximum communications impact,' Belch and Belch, 2004) applied to social development challenges."

Next, a case application describes the use of COMBI for dengue fever prevention and control in Malaysia. Key issues in dengue fever communication are outlined; for example: "a solid understanding of the local cultures and behaviors of affected populations including the general public, health care providers, politicians, policy makers, the media, and the private sector is needed..." The authors suggest that "COMBI's disease- or risk-focused approach as well as its initial application to communication diseases and other so-called 'diseases of poverty' could provide much-needed help to vulnerable populations, relieve them of a significant obstacle that keeps people in poverty, make progress against the most formidable childhood killers, and help strengthen health services."

In addition to acknowledging that COMBI programmes often require substantial resources, the authors stress that the application of Communication-for-Behavioral-Impact must take into account differences among countries and regions within countries. The notion of participation and social mobilisation may be perceived differently by various cultural and geographical groups; for example, in religiously conservative and male-dominated societies, it may be difficult to encourage participation and create large alliances to advocate for taboo topics. "Therefore, the application of COMBI and all other planning frameworks and models should always take into account such differences."

The concluding section explores future directions. The authors note that, although the application of COMBI has been mostly towards health outcomes, its principles and methodologies are relevant to other areas. Examples are provided.

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Pages 535-546 of Emerging Theories in Health Promotion Practice and Research, Second Edition, edited by Ralph J. DiClemente, Richard A. Crosby, and Michelle C. Kegler. San Francisco: Jossey-Bass, 2009.