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Introduction to Behaviour Change Communication

HIV/AIDS Prevention and Control for Humanitarian workers Course notes(http://www.fhi.org/en/hivaids/projects/aidscap+project+page.htm )

The terms BCC and IEC are commonly used. What exactly do they mean and what is the differencebetween BCC and IEC?

Information, Education and Communication:IEC is a process of working with individuals, communities and societies to:- develop communication strategies to promote positive behaviours which are appropriate to their

settings.

Behaviour Change CommunicationBCC is a process of working with individuals, communities and societies to:- develop communication strategies to promote positive behaviours which are appropriate to their

settings; AND- provide a supportive environment which will enable people to initiate and sustain positive

behaviours.

What is the difference between BCC and IEC?Experience has shown that providing people with information and telling them how they should behave(teaching them) is not enough to bring about behaviour change. While providing information to helppeople to make a personal decision is a necessary part of behaviour change, BCC recognizes thatbehaviour is not only a matter of having information and making a personal choice. Behaviour changealso requires a supportive environment. Recalling the interventions model, we learned that behaviourchange communication is influenced by development and health services provision and that theindividual is influenced by community and society. Community and society provide the supportiveenvironment necessary for behaviour change. IEC is thus part of BCC while BCC builds on IEC.

An introduction to BCC programsBefore designing a BCC intervention, it is important to be clear about exactly whose behaviour is to be

influenced and which aspect of their behaviour should be the focus for change. Communities are madeup of different groups with different risk and vulnerability factors. Even within the same broad group,there may be subgroups with distinct characteristics. Different target groups will require differentapproaches. Therefore, when making decisions about which target groups and which factors toaddress, it is necessary to consider:

which target groups are most vulnerable;

which risk / vulnerability factors are most important; which factors may be related to the impact of conflict and displacement; which target groups and risk / vulnerability factors the community wants to address; what could be motivators for behaviour change; what could be barriers to behaviour change;

what type of messages will be meaningful to each target group; which communication media would best reach the target group; which services/resources are accessible to the target group; which target groups and risk / vulnerability factors are feasible in terms of expertise, resources and

time.

A successful BCC program requires careful research and thorough pre-testing of communicationmaterials. It is important not to underestimate the effort that is needed to carry out good qualitybehavioural research, which yields findings that are accurate and useful. A recent analysis by UNHCRof behavioural studies in a number of refugee camps found that the methodology often neededimprovement.

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Research and proper planning form the foundation of an effective communication campaign.Knowing the needs of the population and the best means of reaching that audience are crucial inachieving the goal of raising awareness and, ultimately, changing attitudes and behavioursThe key isto determine the needs and desires of the audience, then deliver messages and products that offer realbenefits. Many social change campaigns fail because the message is not meaningful or relevant andconsequently not motivating to members of the target audience (AIDSCAP/FHI. Control of SexuallyTransmitted Diseases. Chapter 4: An approach to effective communication. Undated: AIDSCAP

Electronic library.)

Behaviour Change Communication for HIV/AIDS (http://www.fhi.org/en/index.htm)Behaviour Change Communication (BCC) is a multi-level tool for promoting and sustaining risk-reducing behaviour change in individuals and communities by distributing tailored health messages in avariety of communication channels.Before they can reduce their risk and vulnerability to HIV, individuals and communities must understandthe urgency of the epidemic. They must be given basic facts about HIV/AIDS, taught a set of protectiveskills and offered access to appropriate services and products. They must also perceive theirenvironment to be supportive of changing or maintaining safe behaviours.

As HIV is primarily a sexually transmitted infection (STI), this requires national and community

discussions on sex and sexuality, risk, risk settings and risk behaviours. It also means dealing at thenational and community levels with the resulting stigma, fear and discrimination.The HIV/AIDS epidemic forces societies to confront cultural ideals and the practices that clash withthem. BCC is vital to this process and can set the tone for compassionate, responsible interventions. Itcan also produce insights into the broader socio-economic impacts of the epidemic.

The strategic role of behaviour change communicationBCC has many different, but related, roles to play in HIV/AIDS programming. Effective BCC should:

Increase Knowledge. BCC should ensure that people have the basic facts in a language,visual medium or other media that they can understand and relate to. Effective BCC shouldmotivate audiences to change their behaviours in positive ways.

Stimulate Community Dialogue. Effective BCC should encourage community and national

discussions on the underlying factors that contribute to the epidemic, such as riskbehaviours, risk settings and the environments that create these conditions. BCC shouldcreate a demand for information and services, and should spur action for reducing risk,vulnerability and stigma.

Promote Advocacy. Through advocacy, BCC can ensure that policy makers and opinionleaders approach the epidemic seriously. Advocacy takes place at all levels, from thenational down to the local community level.

Reduce Stigma and Discrimination. Communication on HIV/AIDS should address stigma anddiscrimination and attempt to influence social responses to them.

Promote Services for Prevention Care and Support. BCC can promote services that addressSTIs, orphans and vulnerable children (OVC), voluntary counseling and testing (VCT) forHIV, mother-to-child transmission (MTCT), support groups for people living with HIV/AIDS

(PLHA), clinical care for opportunistic infections, and social and economic support. BCC canalso improve the quality of these services by supporting providers' counseling skills andclinical abilities.

The goals of behaviour change communicationBCC strategies in HIV/AIDS aim to create a demand for information and services relevant to preventingHIV transmission, and to facilitate and promote access to care and support services. Some specificBCC objectives include:

Increasing the adoption and continued use of safer sex practices; Promoting visits to clinics treating STIs and opportunistic infections, including tuberculosis;

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Increasing the demand for VCT, for MTCT prevention services, and for OVC care andsupport;

Increasing the adoption and continued use of safer drug-injecting practices; Stimulating dialogue and discussion on risk, risk behaviour, risk settings and local solutions;

and Reducing stigma and discrimination for those living with HIV/AIDS.

Essential steps to develop a behaviour change communication strategy

The following steps incorporate careful analysis, feedback and redesign throughout the entire process.Step 1: Identify the problem based on the overall program goals. Step 2: Segment target populations.Step 3: Engage in formative research. Step 4: Identify behaviour change goals. Step 5: Seekconsensus from stakeholders.Step 6: Design communication plan, including objectives, overall theme, specific messages and outletsfor dissemination. Step 7: Pre-test and revise. Step 8: Target communication to specific groups. Step 9:Implement the plan. Step 10: Monitor and evaluate it. Step 11: Seek feedback and make appropriaterevisions.

Lessons Learned. Experience in carrying out BCC interventions has shown that: BCC should be integrated with overall program goals and specific objectives. BCC is an

essential element of HIV/AIDS prevention, care and support programs, providing critical links

with other program components. BCC should be linked to policy initiatives and serviceprovision. BCC should encourage individual behaviour change and also help create environmental

conditions that facilitate personal risk reduction.

Formative assessment or audience research must be conducted to better understand theneeds of the target population and the barriers to behaviour change that its members face.

All BCC in HIV/AIDS should contribute to stigma reduction. The target population and the related community should participate in every phase of BCC

development.

Using a variety of communication channels is more effective than relying on any one. Forexample, peer education should be promoted by mass media, counseling and otherapproaches.

Pre-testing is essential for developing effective BCC materials. Monitoring and evaluation should be incorporated at the start of any BCC program.

Objectives for change after exposure to the communication should be specified. These maybe changes in actual behaviour or shifts in the precursors to behaviour change, such as inknowledge, attitudes or concepts.

Fear campaigns do not work. They contribute to an environment of stigma anddiscrimination.

Because society-wide change is slow, changes achieved through BCC will not be seenovernight.

In conclusionBCC strategies must be based on overall program goals and objectives. They must move beyond

individual communication products to a careful use of many different interventions, products andchannels for a broad community approach.

A BCC strategy that is woven into the overall program and based on sound formative assessment caninfluence community discussion, social norms, and when services and commodities are in place individual and community behaviour.

Those who plan and implement HIV/AIDS programs should develop strategic approaches that viewBCC not as a collection of different, isolated communication tactics, but as a framework of linkedapproaches that function as part of an integrated, ongoing process.

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Resources1. Behaviour Change Communication Handbook Series: Assessment and Monitoring of BCC

Interventions: Reviewing the Effectiveness of BCC Interventions. Behaviour ChangeCommunication for the Prevention and Treatment of STDs. Behaviour Change through MassCommunication: Using mass media for AIDS prevention. HIV/AIDS Care and SupportProjects: Using Behaviour Change Communication Techniques to Design and ImplementCare and Support Projects. How to Conduct Effective Pretests: Ensuring Meaningful BCCMessages and Materials. How to Create an Effective Communication Project: Using the

AIDSCAP Strategy to Develop Successful Behaviour Change. How to Create an EffectivePeer Education Project: Guidelines for AIDS Prevention Projects. Partnership with the Media.Policy and Advocacy in HIV/AIDS Prevention. AIDSCAP/Family Health International, 1996.Arlington, VA. [published in English, French and Spanish]

2. Bertrand, Jane E., Communications Pretesting, Chicago: Community and Family StudyCenter, University of Chicago, Media Monograph 6.

3. Communications Framework for HIV/AIDS; A New Direction, UNAIDS/Penn State, 1999.4. Communications for Behaviour Change: A Toolkit for Task Managers, Cecilia Cabanero

Verzosa, Human Development Department, World Bank, Washington, D.C.5. Diffusion of Innovations, Everett Rodgers, Fourth Addition, The Free Press, 19956. Expanding the global response to HIV/AIDS through focused action; Reducing risk and

vulnerability: definitions, rationale and pathways. UNAIDS Best Practice Collection, Key

Material, UNAIDS October 1997.7. Peer Education and HIV/AIDS, Concepts, Uses and Challenges, UNAIDS Best PracticeCollection, Key Material, December 1999.