CDI Module 19

Behavior Change Communication

©Jhpiego Corporation
The Johns Hopkins University
A Training Program on Community-
Directed Intervention (CDI) to Improve
Access to Essential Health Services

Module 19 Objectives

By the end of this module, learners will
 Define Behavior Change Communication (BCC)
 Differentiate between BCC and Information, Education and
Communication (IEC)
 Identify reasons why people change or do not change behavior
 Discuss basic issues and concepts in BCC
 State key BCC-centered messages to promote acceptance of
integrated community case management (iCMM) by
policymakers, frontline health care providers and community
 Identify basic methods of communicating BCC-centered
messages to the target audience

Basic Issues

Concepts and
Messages for
iCCM Basic BCC
Methods for


Basic Concepts 4 .

Introduction to Behavior Change Learners Brainstorm How can people avoid Are people behaving in getting malaria? these ways? No! But WHY? [Post these as flip chart pages] 5 .

people believe that malaria is a common disease and is not so serious Can you name more reasons? 6 .Why Do People NOT Change Behavior?  People may not  Understand the message  See themselves as vulnerable  Trust the bearers of the message  People may  Think the short-term benefits of current behaviors outweigh the long-term risks  Some “healthy choices” are costly  Recommended behavior may conflict with beliefs  After all.

communities and societies to develop communication strategies  These strategies support positive behaviors that  Promote health  Are appropriate to their settings 7 .Information. Education and Communication (IEC)  IEC is a process of working with individuals.

Behavior Change Communication (BCC) BCC  Develops communication strategies  To promote positive behaviors that are appropriate to their settings AND  Provides a supportive environment that  Will enable people to initiate and sustain positive behaviors 8 .

What Makes an Environment Supportive? What can  Families do?  Local organizations do?  Community leaders do?  Health workers and managers do?  Policymakers do? Who else can contribute to a supportive environment? 9 .

Therefore. BCC Is …  …a process of promoting and sustaining healthy changes in behavior in individuals and communities  This process calls for participatory development of appropriately tailored health messages and approaches  These messages and approaches are conveyed through a variety of communication channels 10 .

Using BCC to Promote Malaria Action 11 .

economic and political environment to be supportive of practicing malaria prevention behaviors 12 .BCC and Malaria Before individuals can reduce their risk/change behaviors they need to  Understand basic facts about malaria  Develop favorable attitudes toward preventive interventions  Long-lasting insecticide-treated nets (LLINs)  Intermittent preventive treatment in pregnancy (IPTp)  Indoor residual spraying (IRS)  Learn a set of skills to implement interventions  Have access to appropriate commodities and services  Perceive their social.

care and support  Reduce stigma and  Improve skills and sense discrimination against of self-efficacy in using poor people who suffer malaria interventions frequently from malaria Can you name more? 13 .What Can BCC Do?  Increase knowledge  Create demand for about malaria information and malaria  Stimulate community services dialog to stop malaria  Advocate for more  Promote essential malaria resources attitude change toward  Promote services for malaria prevention prevention.

Before We Communicate about and Manage Common Illnesses. We Need to Know Their Local Names Medical Name Local Name(s) How Differs from Malaria Malaria Pneumonia Diarrhea Catarrh/Cold Cough Rashes Measles 14 .

Prevention Challenges  What if people believe that malaria is caused by hard work under the hot sun. and only herbal concoctions can prevent it?  What if people think nets are hot and uncomfortable?  What can BCC do? 15 .

More Prevention Challenges What if people use their nets for other purposes? What can BCC 16 do? .

the fever comes  With chills and aches and  At the same time each day.Treatment Challenges Several Diseases Have Hot Body (Fever) In cases of malaria. the fever can come  With a cough and fast or difficult breathing 17 . often between late morning and evening In cases of pneumonia.

Many Diseases Can Have Fever… So We Need a Way to Test  If we give the wrong medicine for the disease. the child will not get well  We can do a special malaria blood test called rapid diagnostic test (RDT)  We can do the RDT in the community 18 .

Using RDTs  Your community-directed distributor (CDD) has been trained to use the RDT correctly and safely  Only a few drops of blood are needed to find out if the malaria “germs” are in the blood  Most RDT results are ready in only 15 minutes 19 .

Positive and Negative RDT Results Lines in “T1” and “T2” NO LINE in “T1” or “T2” and a line in ‘C’ means but a line in “C” means C T1 T2 C T2 T1 Pf or Mixed + Negative the patient DOES have the patient DOES NOT falciparum malaria have either falciparum monoinfection or a mixed malaria or non-falciparum infection malaria 20 .

we look for another disease and treatment 21 .Treatment  We only give malaria medicine when the RDT is positive  New malaria medicine should not be wasted when the person does not have malaria  If the test is negative.

The Communication Challenge  What if the RDT says the person does not have malaria. but she believes she has it and demands malaria medicine?  What can we do?  How can we use BCC to solve this problem? 22 .

Basic BCC Methods 23 .

counseling Provide information cards.Different BCC Methods Address Different Challenges How Method Helps Change Method Behavior Posters. TV. dramas. plays behavior change Provide opportunities to plan Discussions for solving problems 24 . songs action Present role models for Stories. brochures Remind people about malaria Radio.

Using Visual Aids  Visual aids help to enhance understanding  Visual aids include  Posters  Counseling cards  Flip charts  Videos 25 .

Community Counseling Card Give all pregnant women 3 SP Every member of your household Use artemisinin-based tablets beginning from 4 (especially pregnant women and combination therapy (ACT) months (MUST be given after children under the age of five years) when you have malaria baby started moving in MUST sleep under insecticide-treated fever 26 26 mother’s womb) nets .

g. (e..Telling Stories Stories facilitate understanding and are used to pass down a society’s traditions. how misunderstanding the cause of malaria led to the death of a child or pregnant woman)  Testimonials (e. values and norms to future generations  Stories could include  Folktales relating to malaria disease. how RDTs helped to confirm malaria and aided treatment to prevent death)  Cartoon stories 27 ..g.

Composing Songs  Songs reinforce knowledge and help to internalize understanding  Adapting or composing songs about RDT use can help villagers  Understand how they can benefit from using RDTs and accept use  Feel comfortable being tested with RDTs  Songs composed in the local language convey ownership and make issues indigenous 28 .

Role Play and Drama  Theories about behavior change. propose that people develop confidence and willingness to perform a new behavior when they can observe others in their community doing the same  Therefore. role play and drama can build people’s confidence in performing a new skill or practice 29 . for example.

Community Discussion and Planning  Communities need to be actively involved in solving their own malaria problems  Communities can plan how to distribute nets  Communities can select volunteers to treat malaria What else can your communities do? 30 .

fever can come with a cough and fast or difficult breathing  If we give the wrong medicine for the disease. fever may come with chills and aches.Reminder: Some Basic Information  Understanding the signs and symptoms of a disease may enhance its prevention and treatment  In cases of malaria. called RDT. often between late morning and evening  In cases of pneumonia. the child will not get well  This is why we carry out a special malaria blood test. malaria fever comes at the same time each day. at the facility and community levels 31 .

and your CDD has been trained to carry out the test correctly and safely  Be sure to complete the dosage of artemisinin- based combination therapy (ACT) given to you or your ward.Reminder: More Basic Information  This test (the RDT) will help us to know the cause of fever so that we can give the appropriate medicine to your child  The test is safe. even though the fever has stopped  This new medicine is safe for everyone 32 .

regional and national levels to make funds available to control malaria  Making sure that malaria interventions do not cost more than people can afford 33 . Information Alone Is Not Enough We can help create a supportive environment by  Holding community meetings to plan malaria control activities  Ensuring that the health services have adequate supplies of nets and medicines  Advocating with decision-makers at district.Reminder: With BCC.

Small Group Activities  Divide the learners into three groups that will focus on  Promoting use of insecticide-treated nets (ITNs)/LLINs  Seeking prompt diagnosis and correct malaria treatment  Getting IPTp as part of antenatal care (ANC)  Ask each group to plan a BCC program on their topic using locally available materials and media  Groups will report back by sharing their plan and showing examples of their BCC activities 34 .