Points of Convergence

Notwithstanding important persistent differences among theories and approaches, it is possible to identify several points of convergence that suggest possible directions in the field of international communication.

The need of political will

One point of convergence is that political will is necessary in order to bring about change (Hornik 1988). Development communication should not only be concerned with instrumenting specific outcomes as defined in the traditional paradigm, but also with the process by which communities become empowered to intervene and transform their environment. A recent document of the Panos Institute (2000) states that “development communication is about enabling people to shape their own priorities and providing access to information, to power, to channels of communication that enable people to make their voices heard.” Community empowerment should be the intended outcome of interventions. This requires coming up with a set of indicators that measure the impact of interventions in terms of empowerment.

Empowerment lacks a single definition, however. It can refer to communities making decisions for themselves and acquiring knowledge (e.g. about health issues). Whereas for participatory/advocacy approaches empowerment involves changes in power distribution, behavior models use empowerment to represent ways for communities to change behavior, for example, discontinuing unhealthy practices. Advocates of social marketing suggest that marketing empower people by proving information and having constant feedback from consumers so they can be responsible for their well-being.

Because understandings of empowerment are different, expectations about interventions are different, too. If development requires redressing power inequalities, then, it conceivably takes longer time than interventions that aim to change knowledge, attitudes and practices. The pressures for relatively quick results and short-term impact of interventions are better suited for a particular understanding of empowerment (and thus development communication) that is more aligned with behavior change than participatory approaches. The slowness of policy and political changes required for more equal distribution of resources and decision-making, as advocated by participatory models, does not fit short-term expectations.

The problems of measuring results, however, are not unique to participatory strategies. Many observers have indicated that behavior change models have not satisfactorily answered the question of long-term effects. The lack of longitudinal studies that document changes over time makes it difficult to know the extent of the influence of interventions and environmental factors that could help reach solid conclusions about the long-term impact of communication strategies.

The fact that the debate over “results indicators” has not concluded and that no easy resolution seem in sight, reflects the persistence of disagreements over measuring development. Answers to questions such as “what are the right results?” are expected to be different given that, notwithstanding a growing consensus on the issues of community empowerment and horizontal communication as central to development communication, behavior change and participatory models still define the task of interventions in different terms. In other words, there continues to be a tension between approaches that are oriented to achieving results as measured in behavior change and those that prioritize the building of sustainable resources as the goal of programs.

A “tool-kit” conception of strategies

Another important point of convergence is the presence of a “tool-kit” conception of approaches within the behavior change tradition. Practitioners have realized that a multiplicity of strategies is needed to improve the quality of life of communities in developing countries. Rather than promoting specific theories and methodologies regardless of the problem at stake, there has been an emerging consensus that different techniques are appropriate in different contexts in order to deal with different problems and priorities. Theories and approaches are part of a “tool kit” that is used according to different diagnoses. There is the belief that the tools that are used to support behavior change depend on the context in which the program is implemented, the priorities of funders, and the needs of the communities.

For example, conventional educational interventions might be recommended in critical situations such as epidemics when large masses of people need to be reached in a short period of time. Such strategies, however, would be unlikely to solve structural, long-term health problems.

Social marketing could be useful to address certain issues (for example, increase rates of immunization) but is inadequate to address deeper problems of community participation that are ultimately responsible for permanent changes. It also can result in the problem that interventions conclude when public information campaigns are terminated. One of the problems is that such interventions create a dependency on media programs; the alternative, then, is focusing on self-maintaining resources that are responsible for the sustainability of programs. Another problem is that even when social marketing strategies are successful at raising awareness, they do not last forever and, therefore, other support systems are necessary to maintain participation and communication.

Because of the limitations of social marketing, other strategies are needed to address the problem of empowering and politically involving different groups. Social mobilization, for example, offers a way to deal with certain issues such as education, sanitation, nutrition (including breastfeeding), family planning, respiratory problems, AIDS and diarrheal diseases. Still, the mobilization of a vast array of partners is necessary but this does not exclude the uses of media advocacy and social marketing to target specific problems. A breastfeeding program in Brazil successfully integrated social mobilization and social marketing (Fox n.d.). As a result of the program, there was an increase in the median duration of breastfeeding and a reduction in infant mortality. Ministries and professional medical and nutrition groups participated in elaborating plans and stimulating actions at the national and state levels among their employees, members and associated institutions. At the community level, mothers' groups were formed and breastfeeding was promoted through extension workers, university students, the church and other voluntary groups.

Family planning programs in Egypt have been another example of successful integration of different approaches (Wisensale & Khodair 1998). After the intervention, the use of contraceptives doubled and the birthrate dropped from 39.8 to 27.5 percent in ten years. The achievements of the program have been attributed to fact that the Information, Education & Communication Center of the State Information Service used five tools, including the mass media, interpersonal communication, and entertainment-education. The participation of the government, health organizations and religious groups was also considered to be responsible for the success of the program.

The application of any prescriptive theory and methods might not work everywhere. Because of political and religious reasons, it is difficult to bring together a wide spectrum of forces to rally behind issues such as breastfeeding, family planning, and AIDS education in some countries. Under these circumstances, searching for a broad coalition is not recommended. In cases where governments strictly control the mass media or believe that they should be the only actors involved in public information campaigns, then, social marketing interventions confront many problems.

There has been a growing sensitivity to the problems of the universal application of strategies that were successful in specific contexts. In countries where political and cultural factors limit participation and maintain hierarchical relationships, participatory approaches might be difficult to implement as they require a long-term and highly political process of transformation. This does not mean that participation should be abandoned as a desirable goal but that interventions that aim to mobilize communities necessarily adopt different characteristics in different circumstances. Public service announcements may be perceived as contradicting official power and policies. When access to national media is limited or extremely conditional, grassroots strategies whether community participation and local media could offer an alternative. But if populations are afraid of participating for fear of repression or because of past frustrations, then, participatory approaches face clear obstacles and may not be advisable.

Integration of “top-down” and “bottom-up” approaches

Faced with different scenarios and choices, the growing consensus is that a multiple approach that combines “top-down” and “bottom-up” interventions is recommended. Here it becomes evident that development communication has gone beyond transmission models focused on implementing behavior changes through communication activities.

The Iringa Nutrition Improvement Program in Tanzania has been mentioned as a successful example of integrating media advocacy, social mobilization and social marketing (FPRI 1994). The Program included the mobilization of different groups at different levels, community participation, media advocacy to popularize the goals of fighting malnutrition and child mortality, and social marketing to raise awareness among all sectors of the populations. It included “child growth monitoring, strengthening the health infrastructure, health education, and women's activities.” Government commitment, long-term sustainability of the program, and anti-poverty efforts have been mentioned as decisive in contributing to its success in reducing malnutrition despite larger economic problems. Environmental factors such as a tradition of grassroots participation and national policies that dramatically increased literacy were crucial for the success of the program.

Integration of multimedia and interpersonal communication

Much of the current thinking is that successful interventions combine media channels and interpersonal communication. Against arguments of powerful media effects that dominated development communication in the past, recent conclusions suggest that blending media and interpersonal channels is fundamental for effective interventions (Flay & Burton 1990, Hornik 1989).

The media are extremely important in raising awareness and knowledge about a given problem (Atkin & Wallack 1990). The media are able to expose large amounts of people to messages and generate conversation among audiences and others who were not exposed (Rogers 1998). But it would be wrong to assume that development mainly or only requires media channels. Because social learning and decision-making are not limited to considering media messages but listening and exchanging opinions with a number of different sources, as Bandura (1994) suggested, interventions cannot solely resort to the mass media. Although television, radio and other media are important in disseminating messages, social networks are responsible for the diffusion of new ideas (Rogers and Kincaid 1981, Valente et al 1994). Entertainment-education programming is one way, for example to activate social networks and peer communication in the diffusion of information (Rogers et al 1999). Similarly, information given through the media is also important in raising awareness and knowledge as integrated into peer conversations and in contacts with field workers (Mita & Simmons 1995, Ogundimu 1994).

According to McKee (1992), interpersonal communication and the actions of community workers account for much of the success of several projects. Nothing can replace community involvement and education in the effective dissemination of information. Media-centered models are insufficient for behavior change. McKee argues that the most successful strategies in family planning, HIV/AIDS, nutritional and diarrhea programs have involved multiple channels, including strong, community-based programming, networks, peer counseling and government and NGO field workers. Successful initiatives attest to the fact that redundancy and multiple channels should be used. The media has powerful effects only indirectly by stimulating peer communication and thus making possible for messages to enter social networks and become part of everyday interactions.

Without disputing the value of interpersonal communication, McDivitt, Zimick and Hornik (1997) have stressed the importance of the mass media in behavior change (also see Hornik 1988). In an evaluation of the impact of a vaccination campaign in the Philippines, they concluded that the media, rather than interpersonal channels, was responsible for changes in vaccination knowledge. Media exposure was sufficient to generate more knowledge about the specifics of the campaign and change in vaccinations without the intervention of social networks. It would be wrong, according to the researchers, to ignore the unmatched reach of the media, particularly among certain groups, in getting the message out. Mass media messages per se, however, do not explain the success of the campaign. The campaign provided specific information that mothers needed in order to engage in expected behaviors, and other conditions (access to health centers, sufficient vaccine supplies) were also fundamental in making behavior change possible.

Personal and environmental approaches should be integrated

The revision of traditional health promotion strategies and then integration of social marketing and social mobilization are examples of the tendency to integrate personal and environmental approaches.

Consider the “ecological approach” as an example in that direction as used in the North Karelia Project in Finland, the Minnesota Health program, and the Stanford Three Community study (Bowes 1997). It espouses organizational and environmental interventions and aims to be more comprehensive that efforts directed only at individuals or social action (McLeroy, Bibeau, Steckler & Glanz 1988; Glanz & Rimer 1995). Nonbehavioral factors such as unemployment, poverty, and lack of education are included as part of the broad view that ecological approaches encompass. Health promotion should be integrated into existing social systems such as schools, health delivery systems and community organizations. The mentioned projects required coordination among a variety of intermediate agencies that acted as liaisons between developers of health promotion innovation and potential adopters. The focus is still on behavior change but programs feature environmental supports to encourage individuals to adopt and maintain changes (Stokols 1996). Similarly, community participation approaches have recognized the need to promote a “holistic approach” that integrates the contributions of both personal behavior change and broader environmental changes in facilitating health improvement (Minkler 1999).

“Communication for social change” (CSC) is another example of recent efforts to integrate different theories and approaches in development communication (Rockefeller Foundation 1999). Whereas traditional interventions were based on behavior-change models, CSC relies on participatory approaches in emphasizing the notion of dialogue as central to development. Development is conceived as involving work to “improve the lives of the politically and economically marginalized” (1998, 15). In contrast to the sender-receiver, information-based premises of the dominant paradigm, it stresses the importance of horizontal communication, the role of people as agents of change, and the need for negotiating skills and partnership. Another important contribution of CSC is to call attention to the larger communication environment surrounding populations.

In contrast to behavior change and participatory theories that, for different reasons, pay little if any attention to the wide organization of information and media resources, CSC calls attention to the relevance of ongoing policy and structural changes in providing new opportunities for communication interventions. Unlike neo-dependency theories that negatively view worldwide changes in media and information industries as stimulating a process of power concentration, CSC offers a mixed evaluation. It recognizes that transformations open possibilities for community-based, decentralized forms of participation, but also admits that some characteristics of contemporary media are worrisome in terms of the potential for social change. CSC views changes in health and in quality of life in general in terms of citizens' empowerment, a notion that became more relevant in behavior change models (Hornik 1997).

But unlike participatory theories, CSC stresses the need to define precise indicators to measure the impact of interventions. It is particularly sensitive to the expectations of funding agencies to find results of interventions, and to the needs of communities to provide feedback and actively intervene in projects. Here accountability, a concept that is also fundamental in contemporary global democratic projects, is crucial to development efforts. Projects should be accountable to participants in order to improve and change interventions and involve those who are ultimately the intended protagonists and beneficiaries. Because the intended goals are somewhat different from behavior-change approaches, then, it is necessary to develop a different set of indicators that tell us whether changes are achieved (although certainly some measurements traditionally used in health interventions are useful too). The goals are not only formulated in terms that could perfectly fit health promotion/social marketing/behavior change theories (e.g. elimination of HIV/AIDS, lower child and maternal mortality) but also in broader social terms such as eradicating poverty and violence, and increasing employment and gender equality. These goals express a more comprehensive understanding of development that is not limited to “better health and well-being” but is aware of the need to place traditional approaches in larger social and environmental contexts.

Persistent divisions

Despite the cross-pollination of traditions and a multi-strategy approach to interventions, the rift between behavior change and participatory approaches and theories still characterizes the field. The divisions are less pronounced than a few decades ago given the integration of different strategies discussed in the previous section but are still important.

For participatory and advocacy approaches, behavior change models are still associated with a certain scientific paradigm that is questionable on several grounds. Behavior change models are based on premises that do not necessarily translate to developing countries (Stetson and Davis 1999). From a perspective influenced by recent theoretical developments in the social sciences, particularly post-colonial and post-modernist thinking, critics have challenged Western models of rationality and knowledge that inform behavior models. What is necessary is to change the traditional perspective according to which “traditional cultures” are backward and antithetical to development interventions. Because what populations know is considered wrong, local knowledge has been viewed as an obstacle in development interventions. Overcoming ethnocentric conceptions is crucial. It requires to recognize that understandings of information and knowledge are different. Interventions also need to be sensitive to the fact that local cultures do not necessarily fit philosophical assumptions about individual rationality that are embedded in traditional models. Sense-making practices that are found in the developing world contradict key premises of behavior change models, particularly regarding how populations as audiences related to media content and make sense of their worlds by integrating (or not) media content (Tufte 2000). Behavior models assume that individuals engage in certain actions after weighing costs and benefits of the action. Whereas individual interest and achievement are the underlying premises of those models, non-rationalistic forms of knowledge as well community values are central to non-Western cultures.

This is an important issue that underlies many development efforts: the relation between communication interventions and cultural change. Many development programs essentially aim to modify cultural norms. Theoretically, however, this issue has not been sufficiently developed in communication and media studies. We have plenty of examples in which cultures did change and others in which cultures did not, but we lack solid conclusions and nuanced theoretical tools to deal with this issue. The problem remains how to attribute such changes (or lack of) to communication and program interventions. As communication studies moves away from media- and information-centered approaches that dominated the field for decades and puts culture and communities at the center of the analysis, perhaps better-grounded conclusions could be produced. In other words, if the problem is framed in terms of information, media and technology become central and culture is displaced, but if development is understood to be related fundamentally to communities and culture, then a different perspective is possible. Here the issue of generalization is also crucial, that is, how to generalize from experiences of cultural change to others, and whether interventions that, arguably, contributed to modifying norms could be replicated in other contexts and in pursuit of other goals.

Another important point is that critics charge behavior change models for being focused on individual changes while underplaying (or minimizing) the need to instrument larger political transformations that affect the quality of life. They call attention to the organizational structures that inhibit the successful implementation of projects for social change (Wilkins 1999). The concentration of information resources worldwide, the growing power of advertising in media systems, and the intensification of inequalities that underlie the persistence of development problems require more than ever to examine structural-political factors. Media systems have changed dramatically in the last decades. These changes, however, have been particularly revolutionary in the non-Western world as privatization and liberalization of media systems radically transformed the production, distribution, and availability of information resources.

Behavior change models have recognized the merits of insights from participatory approaches as well as the need to be sensitive to media access and new technologies (Piotrow, Kincaid, Rimon, Rinehart 1997). They continue to be mainly concerned with refining analytical and evaluation instruments and measuring the success of different intervention strategies. One of the main tasks is to identify the impact of communication/information campaigns in the context of other factors that affect behavior (Hornik 1997). The integration of social mobilization and social marketing strategies has been found to be successful and a positive referent for future interventions (McKee 1992). Having these issues in mind is important because, as Steson and Davis (1999, 2) write, practitioners need “to be aware of the inherent tensions that exist between the different approaches,” in order to choose which ones are most appropriate in planning and design interventions.

The realization that communities should be the main actors of development communication may constitute a starting point for further integration. Likewise, efforts to integrate theories and strategies that recognize that media campaigns are insufficient without community participation, that social marketing efforts are weak without environmental changes, that community empowerment might be the ultimate goal to guarantee sustainable development, are encouraging to promote dialogue among different theories and traditions.

keywords: change theories

social change