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  1. 1. Dr.P.Getrude Banumathi 1st Year MD SPM, MMC 1
  2. 2. Overview What is behaviour, communication,IEC,BCC Need for BCC Theories on BCC Steps in BCC Developing BCC strategy Communication – skills Major BCC initiatives Critical Success Factors for BCC Challenges for BCC 2
  3. 3. Behaviour The action or reaction of something under specified circumstances The way a person behaves toward other people The aggregate of the responses or reactions or movements made by an organism in any situation 3
  4. 4. Communication • This is a process of transmitting and receiving information on a particular topic between people • It is a process not a product 4
  5. 5. IEC..BCC 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 setting Behaviour Change Communication:  IEC and provide supportive environment which will enable people to initiate and sustain positive behaviors.  BCC is a strategy which refers to the systematic attempt to modify / influence behaviour or practices and environmental factors related to that behaviour, which indirectly or directly promote health, prevent illness or protect individuals from harm 5
  6. 6. What is the difference bt BCC & IEC? IEC : Providing people with information and telling them how they should behave ( teaching..) BCC : Not only information, to help people to make personal decision BCC : Provides supportive environment which will enable people to initiate and sustain positive behaviours IEC is thus part of BCC while BCC builds on IEC. 6
  7. 7. Behaviour Change – Need for prevention Behavior determines whether a person is at risk or not. Those with risky behavior need to change their risky behavior to safe behaviors. Those with safe behaviors need to maintain existing behaviors. Targeted interventions aim behavior change of people with risky behaviors 7
  8. 8. Rights Unsafe Safe STD ,BCC,Condoms, Enabling Environment
  9. 9. Need for BCC ? Disease prevention and health promotion Environment building Establishing need for facilities Generating community participation Women participation and empowerment Utilization of facilities Improving health and hygiene practices Sustainability 9
  10. 10. Theories Inform BCC Two types of behavioral theories are important for BCC programs—theories of behavioral prediction and theories of behavior change. Predictive theories address why people change behavior. They identify what prompts people to perform (or not perform) a health-related behavior. In contrast, behavior change theories explain how people change behavior. They describe the “stages” that individuals may go through as they change their behavior. 10
  11. 11. 1.Prediction Theories Behavioral prediction theories focus on the internal and external factors that influence people’s behavior. 8 factors – explain & predict behaviour: B – Barrier ( Environmental or external constraints ) E – Emotional reaction H A – High Attitude ( Benefits of behaviour out weigh the risk ) VIOUR – Very Important - Intention of OURs S – Social pressure Self Image ( Behavior suits how people see themselves ) Self Efficacy ( Feeling capable of performing behaviour ) Skills ( the necessary abilities to perform the behaviour ) 11
  12. 12. Prediction Theories 3 Important factors are considered necessary and sufficient to perform any behaviour E – Lack of Environmental or external constraints S - Skills ( the necessary abilities to perform the behaviour ) I - Intention Other factors – influences strength and direction of intention E – Emotional reaction H A – High Attitude ( Benefits of behaviour out weigh the risk ) S – Social pressure Self Image ( Behavior suits how people see themselves ) Self Efficacy ( Feeling capable of performing behaviour ) 12
  13. 13. 2.Behavior Change Theory Prochaska and DiClemente (1986) and their colleagues have formally identified the dynamics and structure of staged behaviour change. The Stages of Behaviour Change Theory, identifies five phases: Precontemplation, Contemplation, Preparation, Action, and Maintenance 13
  14. 14. Behavior Change Theory Describe Process of Change 14
  15. 15. Behavior Change Theory 15
  16. 16. Behavior Change Theory  Prochaska and DiClemente further suggest that behavioural change occurs in a cyclical process that involves both progress and periodic relapse. Even with successful behaviour change, people likely will move back and forth between the five stages for some time, experiencing one or more periods of relapse to earlier stages In successful behavioural change, while relapses to earlier stages inevitably occur, individuals never remain within the earlier stage towhich they have regressed, but rather, spiral upwards, until eventually they reach a state where most of their time is spent in the maintenance stage. 16
  17. 17. 3.Stage Theory by Sallis & Nader In 1992, Prochaska suggests that behaviour change can only take place in the context of an enabling or supportive environment. Consistent with the above perspective, Sallis and Nader (1988) also have suggested a stage approach to explaining movement behaviour, particularly in family groups aimed at understanding better the cyclical patterns of movement activity involvement, including adoption, maintenance, and relapse, and interventions 17
  18. 18. 4.Roger”s Stage Theory Parallel with the work of Prochaska and DiClemente, Rogers, (1983) also developed a stage-based theory to explain how new ideas or innovations are disseminated and adopted at the community and population levels. Rogers identified five distinct stages in the process of diffusion of any new initiative or innovation. Knowledge, Persuasion, Decision, Implementation, Confirmation. 18
  19. 19. Roger”s Stage Theory Rogers argued that the diffusion of an innovation is enhanced when the perceived superiority of an innovation is high compared to existing practice (i.e. the relative advantage), and Other important influences on the diffusion process are said to be complexity, triability, and observability, with innovations which are of low complexity, easily observed Rogers classifies individuals as innovators, early adopters, early majority, late majority, late adopters, and laggards, dependent upon when during the overall diffusion process they adopt a new idea or behaviour. 19
  20. 20. 5.Social Cognitive-Behavioural Theory Explains human behaviour in terms of a triadic, dynamic and reciprocal model in which behaviour, personal factors, and environmental influences interact Self-efficacy is one of the key concept of this theory Self-efficacy expectations have been found repeatedly to be important determinants of: a. the choice of activities in which people engage b. how much energy they will expend on such activities and c. the degree of persistence they demonstrate in the face of failure and/or adversity. Higher levels of self-efficacy for a given activity are associated with higher participation in that activity20
  21. 21. 6.Attribution Theory Individuals generally view their performance (and thus, their successes and failures) as dependent upon ability, effort, task difficulty, and luck When failure is attributed to low personal ability and a difficult task, individuals are more likely to give up sooner, select easier alternatives, and lower their goals. Conversely, when failure is attributed to external factors such as bad luck, individuals are likely to have higher motivations to continue and to try again for success. 21
  22. 22. 7.Learning and Behaviour Theory Learning theorists have demonstrated that behaviour can be changed by providing appropriate rewards, incentives, and/or disincentives. 8.Social Learning Theory Social learning theory views the individual as an active participant in his or her behaviour, interpreting events and selecting courses of action based on past experience. 22
  23. 23. 9.Social Psychological Theory Social psychological theories are concerned with understanding how events and experiences external to a person (i.e. aspects of the social situation and physical environment) influence his or her behaviour. Emphasis is placed on aspects of the social context in which behaviour occurs, including social norms and expectations, cultural mores, social stereotypes, group dynamics, cohesion, attitudes and beliefs. 23
  24. 24. 10.Social Cognitive Approach Social-cognitive approaches emphasize the person's subjective perceptions and interpretations of a given situation or set of events For example, the social reality of a the group (e.g. peer group, school group, family group etc.) will affect an individual's behaviour. All groups are characterized by certain group norms, beliefs and ways of behaving, and these can strongly affect the behaviour of the group members. 24
  25. 25. 11.Health Brief Model The Health Belief Model attempts to explain health-behaviour in terms of individual decision-making, and Proposes that the likelihood of a person adopting a given health-related behaviour is a function of that individual's perception of a threat to their personal health, and their belief that the recommended behaviour will reduce this threat. 25
  26. 26. 12.Social Marketing The concept of social marketing is based on marketing principles and focuses on four key elements, including: Development of a product Promotion of the product Place Price  It proposed framework, which situates people as "consumer" who will potentially "buy into" a certain idea or argument, given the appropriate selling techniques are applied. 26
  27. 27. 13.Interpersonal Behaviour Theory  Habit is an important element of the theory of interpersonal behaviour, which proposes that the likelihood of engaging in a given behaviour is a function of: a. the habit of performing the behaviour b. the intention to perform the behaviour c. conditions which act to facilitate or inhibit performance of the behaviour While individuals must first intend to participate in a given behaviour or activity, as the behaviour or activity is repeated over many occasions, participation becomes habitual and requires little conscious intervention. 27
  28. 28. Which Theory / Model / Approach ??? While each theory tends to offer unique concepts and insights differences seem to be more a matter of emphasis, focusing on different aspects of behaviour, rather than complete contradictions.  No one theory is right or wrong. Rather, it is a matter of deciding: (a) which theories and/or concepts have most relevance and usefulness with respect to a given issue or question (b) at which stage of the overall stage process will the various theories and concepts have most meaning and application. 28
  29. 29. Steps in BCC Knowledge Approval Intention Practice Advocacy (motivating others to change) Not all people go through all steps systematically & Identify where your audience on the steps to BCC and help them to move on 29
  30. 30. BCC must be Research based Client based Benefit oriented Service linked Professionally developed Education focused Program sustainable 30
  31. 31. Steps in developing BCC Strategy Strategy :Set of chosen activities to achieve long term objectives and goals. 31
  32. 32. 1.0 BCC Program goals :  Clearly identifying overall program goals is the first step in developing a BCC strategy.  Specific BCC program goals are established after reviewing existing data, epidemiological information and in-depth program situation assessments. 32
  33. 33. 2.0 Stake Holder : A Person or group with an interest in the outcome of intervention.  Policy makers  Opinion leaders  Community leaders  Religious leaders  Members of target population 33
  34. 34. 3.0 Target Population ( for HIV – BCC ) : 34
  35. 35. 4.0 Conducting BCC assessment( for HIV – BCC ) 35
  36. 36. 5.0 Segment Target Population: Psychological characteristics : Knowledge, attitude & practices. Demographic characteristics : including age, place of residence, place of birth, religion & ethnicity. 36
  37. 37. 6.0 Define Behaviour change objectives FOR HIV / AIDS  Increased safer sexual practices  Increased incidence of health seeking behaviour  Increased use of universal precautions to improve blood safety  Increased blood donations  Improved compliance with drug treatment regimens  Increased use of new / disinfected syringes and needles 37
  38. 38. 7.0 Design of BCC Strategy : A well designed BCC strategy should include  Clearly defined BCC objectives  An overall concept or theme and key messages  Identification of channels of dissemination  Identification of partners for implementation (including capacity- building plan)  A monitoring and evaluation plan 38
  39. 39. 8.0 Communication : SRMC F Communication Components : 1. 3. 4. Channel 5. 2. 39
  40. 40. People communicate through: Voice, tone, body movement, touching, facial expression, eye Contact. Areas of observation: 􀂄 Physical: body-build, physical appearance, level of Energy 􀂄 Emotional: facial expression, the eyes, the lips if tight or relaxed posture, body stance, grooming 􀂄 Interpersonal: How she relates to you positively, negatively, neutrally 40
  41. 41. Seven ‘C’s of communication A - Command Attention Call for Action B - Communicate a Benefit C - Clarify the message Consistency Counts D - Create Definite belief E – Emotional (Cater to the Heart & head ) 41
  42. 42. Types of communication: • Intra-personal: Communication with oneself • Interpersonal: Face to face communication between Individuals 42
  43. 43. • Mass communication: An individual communicating with many people. Such as through radio. • Organizational communication: Communication among groups or within groups 43
  44. 44. Interpersonal communication : • This is a two-way communication process i.e. a dialogue • Good interpersonal communication skills are essential in order to enhance client/provider interactions. 44
  45. 45. Elements of Interpersonal Communication : 1. Foundation • Non - judgemental • Observe Non verbal communication • Respect • Empathy 2. Good Interactions • Reassurance • Two-way 3. Knowledge Ideas/sharing experiences 45
  46. 46. Interpersonal Communication Skills : In order for health workers to communicate effectively, they require to have several types of communication skills. These are: • Effective listening skills • Observation skills To remember • Paraphrasing Listen - OPQRS • Questioning skills • Rapport establishment • Reflecting and, • Summarising 46
  47. 47. Skill of Listening… Hearing alone is not listening! Steps of listening 􀂄 Know what you are listening for 􀂄 Listen to specific content (who, what, where, when, why) 􀂄 Suspend your personal judgment 􀂄 Resist distractions, thoughts, imaginations which take your attention from the client 47
  48. 48. Importance of rapport in client-provider interaction : • Establishing rapport is a critical step in effective communication. • It’s enables clients/patients to express themselves adequately. • When rapport is well established, information is well understood, and clients are likely to comply with advice. 48
  49. 49. Clients’ / patients’ roles: 1.Expect good care - Repeat their request for information 2.Elicit information - • Ask questions • Check their own understanding of information and instructions 3.Disclose information - • Volunteer information about their preferences, needs, and problems • Openly discuss their personal situation 4.Make thoughtful decisions - • Discuss the advantages and disadvantages • instructions and any other help they may need to carry out the decision 49
  50. 50. The health provider’s role: 1.Establish rapport: • Be positive and encouraging • Listen and observe what clients say and do 2. Focus on the individual: • Respond first to the client’s stated need, interest, or question • Respond to the client’s concerns, including rumors, respectively and constructively. 3. Communicate medical information and facts clearly: • Use simple, non-technical language • Do not give irrelevant or too much information at once • Encourage questions and make time for them 4. Advise and encourage clients to choose correct option: 5. Empower clients/ patients • Help clients/patients to understand the dangers of unsafe practice 50
  51. 51. Types of IEC materials: some examples Leaflets Audio tapes Posters Films Pamphlets Video Fliers Games Flip charts Comics Flip books Puppets Cinema slides Theatre Exhibitions Local arts 51
  52. 52. 9.0 Conduct pre-testing : Pre-testing should be done of themes, messages, prototype materials, training packages, support to BCC formative assessment instruments. Pre-testing of media, messages and themes should evaluate: Comprehension Attraction Persuasion Acceptability Audience member’s degree of identification 52
  53. 53. 10.0 Implement & Monitoring : Monitoring is part of the ongoing management of communication activities, and it usually focuses on the process of implantations. The following should be closely monitored. Reach : Are adequate numbers of the audience being reached over time? Coordination: Are messages adequate coordinated with service and supply delivery and with other communication actives? Are communication activities taking place on schedule, at the planned frequency? 53
  54. 54. Scope: Is communication effectively integrated with the necessary range of audiences, issues and services. Quality: What is the quality of communication (message, media and channels)? Feedback: Are the changing needs of target populations being captured? In the implementation phase, all elements of the strategy of into operation. An especially important element is management. All Partners, programmers and channels of the BCC strategy must be closely coordinated. 54
  55. 55. 11.0 Evaluate Evaluation refers to the assessment of a project’s implementation and its success in achieving predetermined objectives of behavior change. BCC interventions should be evaluated against their stated objectives and in reference to a baseline that may be qualitative or quantitative (or both). Change can also be assessed through qualitative research into target-group response to intervention. 55
  56. 56. 12.0 Elicit feedback & modify program As program evolve, target population acquire new knowledge and behaviors, and communication needs may change. Day-to-Day monitoring will provide in formations for making adjustments in short- term work planning. Periodic program reviews can be designed to take a more in-depth look at program progress and larger-scale adjustments or design. 56
  57. 57. Major BCC Initiatives Health Education in WG, SHGs School Sanitation Programme Users Education Programme Health Education for Adolescent Girls Cleaning Campaigns HIV prevention programs Malaria control programs Safe injection practices Safe drinking water Family planning services…. 57
  58. 58. BCC Initiatives : Communication Team Programmes Health Camps Village Sanitation Rallies Video story-based intervention Puppet Shows and Cultural Programmes Demonstrations 58
  59. 59. BCC Initiatives : Other Methods : Local songs Poems Posters and picture cards Slogan writing on wall Model aid health discussions Quiz competitions Role plays Dramas 59
  60. 60. Health Dept operationalises BCC cell  ♦ The State Health and Family Welfare Department under the agency of National Rural Health Mission (NRHM) operationalised an integrated Behavioural Change Communication (BCC) Cell at the State Institute of Health and Family Welfare.  ♦ The BCC cell would facilitate an integrated communication planning to make interventions under NRHM, Integrated Child Development Scheme (ICDS), Sarva Siksha Abhiyaan, Total Sanitation Campaign, National AIDS Control Programme more effective and making maximum impact on the people. and trust. 60
  61. 61. Critical Factors for Success of BCC : Selection of the most critical target behaviors Appropriate channels for communication Adopting a systems approach that actively integrated all components of the initiatives. An element of participatory approach, with gender. Focus on both the health and non-health benefits of the project. A system of transparency, accountability and trust. 61
  62. 62. Challenges to BCC : Integrating BCC into all programs Limited training resources Political and physical enviroment Sustainability Expanding the response Budgets 62
  63. 63. 63

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