Behaviour Change Communication in Public Health

Summary

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A Generation Ago...

Monologue: The "Medical Era"

Expert (sender) sending messages to non-expert (receiver)

The 70s: "Field Era"

Moving from monologue to dialogue

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 80s: "Social Marketing Era"

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

The 90s to Present: "Strategic Era"

Moving from dialogue to mutual adjustment and convergence

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
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 sub-national level
Role of electronic media more pervasive

Developing World Radio and TV Receivers

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.

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...

12 Key Elements of Strategic Communication: Making Evaluation More Complex

Results-oriented	Multi-channeled
Science-based	Technically high quality
Client-centered	Advocacy-related
Participatory	Expanding to scale
Benefit-oriented	Programmatically sustainable
Service-linked	Cost-effective

Strategic Directions in HIV/AIDS Behavior Change Communication

More applications of theory-driven communication and behavior change at multiple levels

Theory Driven Behavior Change Communication

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

Cleland & Wilson, 1987

A predictive model of communication & change:

Influence of ideational element on behavior

Ideational Factors Related to Condom Use (Zambia)

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

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