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. 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. Communication
• This is a process of transmitting and receiving
information on a particular topic between people
• It is a process not a product
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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
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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.
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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
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8. Rights
Unsafe Safe
STD ,BCC,Condoms,
Enabling Environment
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. 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.
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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 )
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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. 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
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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.
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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
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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.
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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.
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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. 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. 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.
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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.
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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.
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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.
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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.
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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. 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.
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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
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30. BCC must be
Research based
Client based
Benefit oriented
Service linked
Professionally developed
Education focused
Program sustainable
30
31. Steps in developing BCC Strategy
Strategy :Set of chosen activities to achieve long term objectives and goals. 31
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.
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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
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36. 5.0 Segment Target Population:
Psychological characteristics :
Knowledge, attitude & practices.
Demographic characteristics :
including age, place of residence, place of birth,
religion & ethnicity.
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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
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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
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39. 8.0 Communication :
SRMC F
Communication Components :
1. 3.
4. Channel
5.
2.
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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
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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 )
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42. Types of communication:
• Intra-personal: Communication with oneself
• Interpersonal: Face to face communication between
Individuals
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43. • Mass communication: An individual communicating with
many people. Such as through radio.
• Organizational communication: Communication among
groups or within groups
43
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. 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
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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
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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
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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.
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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
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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
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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
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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
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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?
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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.
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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.
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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.
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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….
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58. BCC Initiatives : Communication Team
Programmes
Health Camps
Village Sanitation Rallies
Video story-based intervention
Puppet Shows and Cultural Programmes
Demonstrations
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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
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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.
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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.
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62. Challenges to BCC :
Integrating BCC into all programs
Limited training resources
Political and physical enviroment
Sustainability
Expanding the response
Budgets
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