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 difference between 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 Communication BCC 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 help people to make a personal decision is a necessary part of behaviour change, BCC recognizes that behaviour is not only a matter of having information and making a personal choice. Behaviour change also requires a supportive environment. Recalling the interventions model, we learned that behaviour change communication is influenced by development and health services provision and that the individual is influenced by community and society. Community and society provide the supportive environment necessary for behaviour change. IEC is thus part of BCC while BCC builds on IEC. An introduction to BCC programs Before 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 made up 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 different approaches. Therefore, when making decisions about which target groups and which factors to address, 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 communication materials. It is important not to underestimate the effort that is needed to carry out good quality behavioural research, which yields findings that are accurate and useful. A recent analysis by UNHCR of behavioural studies in a number of refugee camps found that the methodology often needed improvement.

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 in achieving the goal of raising awareness and, ultimately, changing attitudes and behavioursThe key is to determine the needs and desires of the audience, then deliver messages and products that offer real benefits. Many social change campaigns fail because the message is not meaningful or relevant and consequently not motivating to members of the target audience (AIDSCAP/FHI. Control of Sexually Transmitted 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 riskreducing behaviour change in individuals and communities by distributing tailored health messages in a variety of communication channels. Before they can reduce their risk and vulnerability to HIV, individuals and communities must understand the urgency of the epidemic. They must be given basic facts about HIV/AIDS, taught a set of protective skills and offered access to appropriate services and products. They must also perceive their environment 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 the national 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 with them. BCC is vital to this process and can set the tone for compassionate, responsible interventions. It can also produce insights into the broader socio-economic impacts of the epidemic. The strategic role of behaviour change communication BCC 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 should motivate 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 risk behaviours, risk settings and the environments that create these conditions. BCC should create 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 opinion leaders approach the epidemic seriously. Advocacy takes place at all levels, from the national down to the local community level. Reduce Stigma and Discrimination. Communication on HIV/AIDS should address stigma and discrimination and attempt to influence social responses to them. Promote Services for Prevention Care and Support. BCC can promote services that address STIs, orphans and vulnerable children (OVC), voluntary counseling and testing (VCT) for HIV, 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 can also improve the quality of these services by supporting providers' counseling skills and clinical abilities. The goals of behaviour change communication BCC strategies in HIV/AIDS aim to create a demand for information and services relevant to preventing HIV transmission, and to facilitate and promote access to care and support services. Some specific BCC objectives include: Increasing the adoption and continued use of safer sex practices; Promoting visits to clinics treating STIs and opportunistic infections, including tuberculosis;

Increasing the demand for VCT, for MTCT prevention services, and for OVC care and support; 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: Seek consensus from stakeholders. Step 6: Design communication plan, including objectives, overall theme, specific messages and outlets for 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 appropriate revisions. 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 service provision. 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 the needs 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. For example, peer education should be promoted by mass media, counseling and other approaches. 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 may be changes in actual behaviour or shifts in the precursors to behaviour change, such as in knowledge, attitudes or concepts. Fear campaigns do not work. They contribute to an environment of stigma and discrimination. Because society-wide change is slow, changes achieved through BCC will not be seen overnight. In conclusion BCC 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 and channels for a broad community approach. A BCC strategy that is woven into the overall program and based on sound formative assessment can influence 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 view BCC not as a collection of different, isolated communication tactics, but as a framework of linked approaches that function as part of an integrated, ongoing process.

Resources 1. Behaviour Change Communication Handbook Series: Assessment and Monitoring of BCC Interventions: Reviewing the Effectiveness of BCC Interventions. Behaviour Change Communication for the Prevention and Treatment of STDs. Behaviour Change through Mass Communication: Using mass media for AIDS prevention. HIV/AIDS Care and Support Projects: Using Behaviour Change Communication Techniques to Design and Implement Care and Support Projects. How to Conduct Effective Pretests: Ensuring Meaningful BCC Messages and Materials. How to Create an Effective Communication Project: Using the AIDSCAP Strategy to Develop Successful Behaviour Change. How to Create an Effective Peer 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 Study Center, 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, 1995 6. 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 Practice Collection, Key Material, December 1999.