sbcc in public health

1. Social and Behavior Change
Communication approach in Public
Health
Dr. Aleena Maskey
JR 2019
SPH&CM
9th November 2020
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2. CONTENT
• Introduction
• Social and behavior change communication (SBCC)
• Theories of SBCC
• Importance of SBCC
• SBCC Strategy approaches
• Steps of SBCC
• SBCC Strategy
• Shape-up Somerville SBCC initiative
• Conclusion
• References
2

3. Introduction
• Behavior is a complex phenomenon, influenced by factors
within the individual and beyond.
• The Social Ecological Model, recognizes four levels of
influence that interact to affect behavior: individual, family
and peer networks, community and social/structural.
• Behavior determines whether a person is at risk or not.
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4. 4

5. Smoking
Alcohol
Dietary
Physical Activity
Non communicable
diseases such as
(NCDs)
• Diabetes
• Obesity
• Hypertension,
• Cancers, etc.
Sexual Activity
Substance abuse
HIV, STD, Hepatitis
Rash Driving
Road Traffic Accidents
Mental Disorders
Healthy
life
Behaviour Public Health
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6. INTRODUCTION
• Emphasis in public health interventions have been on
changing behaviors or intervening early on to decrease the
negative impacts that come with these behaviors.
• With successful intervention, there is possibility of decreasing
healthcare costs, as well as general costs to society (morbidity
and mortality).
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7. INTRODUCTION
• Behavior change, in context of public health, refers to efforts
put in place to change people's personal habits and attitudes,
to prevent disease.
• Behavior change in public health is also known as social and
behavior change communication (SBCC).
• More and more, efforts focus on prevention of disease to save
healthcare care costs.
• This is particularly important in low and middle income
countries where health interventions have come under
increased scrutiny because of the cost.
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8. Social and behavior change
communication (SBCC)
• Previously known as behavior change communication (BCC),
SBCC is an interactive process for developing messages and
approaches using a strategic mix of communication channels
to reach multiple levels of society in order to encourage and
sustain positive and appropriate behavior.
• BCC was first employed in HIV and TB prevention projects.
• More recently, SBCC has grown to encompass any
communication activity whose goal is to help individuals and
communities select and practice behavior that will positively
impact their health, such as immunization, cervical cancer
check up, employing single-use syringes, etc.
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10. • A key element of behavior change interventions involves
negotiation with the individual or community for behavior
change. Ultimately it involves negotiation with ‘Self’ to
practice desired behavior.
• It uses dialogue, messages, persuasion, interpersonal and
group communication to exchange information, ideas, skills
and values aimed at bringing about behavior change.
• It employs a systematic process beginning with formative
research and behavior analysis and is based on the
communication, planning, implementation, monitoring and
evaluation.
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11. SBCC is a Process
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12. • Programs are designed on the basis of existing data, analyzing
the problem in order to define barriers and motivators to
change, and design a comprehensive set of tailored
interventions that promote the desired behaviors.
• An SBCC strategy is the document that guides the design of
interventions, establishing intended audiences, setting
behavioral communication objectives and determining
consistent messages, materials and activities across channels.
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13. • Participation of the stakeholders are vital at every steps of
planning and implementation of the behavior change
programs to ensure sustainable change in attitude and
behavior.
• SBCC has proven effective in several health areas, such as
increasing the use of family planning methods, preventing HIV
and AIDS, reducing the spread of malaria and other infectious
diseases, and improving newborn and maternal health.
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15. • Effective SBCC interventions should aim to develop messages
and activities that influence all four levels of the Social-
Ecological Model, maximizing the facilitators and limiting the
barriers.
• It is important to recognize, however, that it is unlikely for one
single organization to be able to operate at all four levels, as
these often require different skills, strategies and approaches.
• Coordination and partnerships with institutions and
organization that operate at different levels are therefore
necessary for a comprehensive SBCC approach.
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16. Social norms and public policies influence behavior change.
A strategic shift must bealso be attempted simultaneously.
Behavior change communication is not a stand alone
strategy.
It has to be used in conjunction with other strategies such as
for HIV prevention campaigns medical treatment i.e. STD
treatment and creation of enabling environment should be
used along with SBCC approach.
BCC often complements and supports other prevention
strategies and approaches.
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17. Behavior Change Theories
• SBCC and communication theories provide researchers and
practitioners with frameworks for understanding human
behavior, potential for change and how changes in behavior may
happen over time.
• Theory can guide the design, implementation of evidence-
based programs, and evaluations. Adequately addressing an
issue may require more than one theory, and no one theory is
suitable for all cases.
• They are therefore useful tools to inform SBCC program
design and to highlight areas on which to focus.
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18. • Several commonly used theories exist; however, this section
describes few that are most important :
• The Health Belief Model (Becker 1974)
• The Theory of Reasoned Action (Ajzen & Fishbein 1980)
• The Theory of Planned Behaviour (Ajzen 1991)
• The Stages of Change Model (Prochaska & DiClemente 1984)
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19. The Health Belief Model (Rosenstock
1966; Becker 1974)
• Used to predict protective health behavior like vaccination
uptake and compliance with medical advice.
• For behavior change to take place, individuals must have an
incentive to change, feel threatened by their current behavior,
feel a change would be beneficial in some way and have few
adverse consequences and must feel competent to carry out
the change.
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21. The Theory of Reasoned Action (Ajzen
& Fishbein 1980)
• Behavior is dependent on 2 variables.
• Attitudes – beliefs about consequences of behavior
and evaluating positive and negative aspects of making
a change
• Subjective norms – what ‘significant others’ do and expect and
the degree to which person wants to conform & be like others
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23. The Stages of Change Model
(Prochaska & DiClemente 1984)
Unaware
Aware
Concerned
Knowledgeable
Motivated to change
Practicing trial BC
Sustained BC
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24. The Behavior Change Spiral in the
context of the Enabling Environment
Social features
eg nature of personal
relationships; expectations
of class, position, age,
gender; access to
knowledge,
information.
Cultural features
- the behaviors and
attitudes
considered acceptablein
given contexts - eg relating to
sex, gender, drugs, leisure,
Ethical and spiritual
features - influence of
personal and shared
values
and discussion about
moral
systems from which those
are derived - can include
rituals, religion and rights
of passage
Legal Features - laws
determining what peoplecan
do and activities to
encourage
observance of those laws
Political features -
systems
of governance in which
change will have to take
place - can, for example,
limit access to information
and involvement in social
action
Resource features - affect
what is required to make
things happen - covers
human, financial and material
resources; community
knowledge and skills; and
items for exchange
6
Features
of
the
Enabling
Environment
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25. Audiences along a Behavior Change Continuum:
Possible Communication Strategies
Unaware
Aware, concerned,
knowledgeable
Motivated to Change
Tries New Behavior
Sustains New Behavior
•Raise awareness
•Recommend a solution
•Identify perceived barriers and
benefits to behavior change
•Provide logistical information
•Use community groups to counsel and
motivate
•Provide information on correct use
•Encourage continued use by emphasising
benefits
•Reduce barriers through problem solving
•Build skills through behavioral trials
•Social support
•Remind them of benefits of new behavior
•Assure them of their ability to sustain new
behavior
•Social support 25

26. Importance of SBCC
• Increase in knowledge and attitude of the people.
• It helps to trigger and stimulate people for adopting positive
behavioral approaches.
• It promotes appropriate and essential attitude change.
• As BCC strategies and messages are tailored for specific target
groups, these strategies are efficient and effective.
• BCC approaches are more sustainable and acceptable.
• It helps to increase learning and skills.
• It improves aptitudes and feeling of self-adequacy.
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27. Percentage CSWs having knowledge, intent, trial
and maintainence for use of condom-
Bangladesh
37.8
27.8
14.6
6.3
40
35
30
25
20
15
10
5
0
Knowledge Intent Trial Maintenance
Knowledge= knows about use of condoms prevent STD; Intent=desire to use condom; Trial= tried condom at
aleast once in last 24 hrs; Maintanence= used condom>50% of all last sexual encounter in last 24 hrs
www.drjayeshpatidar.blogspot.in 27

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29. 29

30. Evidence for SBCC as high impact practice1 for
Family Planning: a review of 49
articles,1980-2009
Strong association of use of contraceptives to
communication program exposure
Both direct and indirect exposure contributes to increased
use of modern contraceptives
Exposure to multi-media has a greater impact: increase in
odds ratio from1.6 to 10.2 by dose of exposure
Mass media programs are found to be cost effective: cost
per new adopter ranges from USD 1.57 to USD 17.72.
• 1 Johns Hopkins Center for Communication Programs. SUMMARY REPORT: reviewing existing evidence on the
• contribution of communication interventions to increasing family planning use, January 2010.
Source: Arzum Ciologlu, JHU-CCP, ppt with C-Change, URC on SBCC as High Impact Practice for USAID 30

31. SBCC strategy approaches
• Using a thoughtful blend of multiple approaches increases an
audience’s exposure to messages.
• It also increases repetition of the message, allowing different
channels to reinforce meaning.
• Repeat exposure improves the likelihood that a message will
be understood, accepted and acted upon.
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32. • A combination of approaches, which include:
• Advocacy
• Mass Media
• Support Media/Mid-Media
• Community-Based Media
• Community Mobilization
• Social Mobilization
• Counseling
• Interpersonal Communication/Peer Communication
• Distance Learning
• Information and Communication Technology
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33. SBCC Operates Through Three Key
Strategies
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34. 1.Advocacy
• Advocacy is the act of putting a case persuasively before a
target audience.
• It is a set of targeted actions, which aim to ensure support for
program implementation at all levels.
• Types of Advocacy:
– Policy Brief
– Media advocacy
– Lobbying
• Three stages: Information gathering, strategizing and action
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35. 2.Social Mobilization
• Social mobilization is the process of bringing together all
societal and personal influences to raise awareness of and
demand for health care, assist in the delivery of resources and
services, and cultivate sustainable individual and community
involvement.
• In order to employ social mobilization, members of
institutions, community partners and organizations, and
others collaborate to reach specific groups of people for
intentional dialogue.
• Social mobilization aims to facilitate change through an
interdisciplinary approach.
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36. 36
3.BCC approaches

37. • The approaches chosen drive the SBCC program and help
ensure consistency and coordination among partners and
synergy across program interventions.
• The strategic approaches can be incorporated into a goal-
oriented campaign.
• Campaigns include a combination of approaches (usually
including mass media in addition to community-based
approaches) and provide multiple opportunities for exposure
through a consistent theme that links program activities
together.
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38. • A campaign provides benefits to the individual and/or society,
typically within a given time period, by means of organized
communication activities .
• Strategic approaches are often depicted through a strategic
framework, which shows how activities will contribute to
objectives.
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39. Steps of Social and Behavior
Change Communication (SBCC)
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40. 41

41. Communication Strategy
• Health communication in the 1990s to the present has
evolved into what may be called the “strategic era,”
characterized by multichannel integration, multiplicity of
stakeholders, increased attention to evaluation and evidence-
based programming, large-scale impact at the national level,
more pervasive use of mass media, and a communication
process in which participants (“senders and receivers”) both
create and share together.
• Communication strategy involves steps to develop
need-based messages that are more likely to influence
audience.
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42. Steps in Communication Strategy
• Situation Analysis
• Audience Segmentation
• Determining Barriers
• BCC Objectives
• Effective Message
• Channels & Tools
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43. 1. Situation Analysis
• Defining Purpose (Health situation that the program is
trying to improve)
• Key Health Issue (Behavior or change that needs to occur to
improve the health situation)
• Context (Strengths, Weaknesses, Opportunities, and
Threats that affect the health situation)
• Gaps in information that limit the program’s ability to
develop sound strategy.
• Formative Research to address gaps
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44. 2. Audience Segmentation
• Which group of people is most affected by the problem
(primary audience)?
• Which group of people influence the primary audience and
to what extent?
• Addressing which group will provide the “tipping
point” to change?
• How are the power dynamics between the people we
will be dealing with?
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45. 3. Determining Barriers
• Facilitating behaviour change requires that the barriers to
change should be reduced so that people can try out and
adopt new and useful behaviours.
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46. •Poor knowledge of cord care
•Poor knowledge of skin-to-skin care
•New born believed as impure unless bathed
•Early discharge leading to low postnatal
checkups
•Lack of knowledge about danger signals for
mother and child after delivery
•Poor advice by health workers coupled with lack of
perceived need in families for post-natal care
Barriers to new-born care
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47. 4.Behaviour Change Communication
Objectives
• Communication objectives should be more than just the
specific behaviours that we want to change. They should
address barriers that people experience in performing a
specific behaviour
• Objectives will clarify the following:
– What changes in policies, service delivery, and social
norms does one expect?
– What changes in knowledge, attitudes and behaviour of
each audience segment does one expect
• BCC objectives should focus on motivation and the ability
to act
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48. Communication
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49. Types of Communication
• One way
• Two way
• Verbal
• Non-verbal
• Formal and informal
• Visual
• Telecommunication and internet
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50. • Seven Cs of effective communication
1. Command attention
2. Cater to the heart and head
3. Clarify the message
4. Communicate a benefit
5. Create trust
6. Convey a consistent message
7. Call for action
5.Effective Message
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52. 6. Channels and Tools
• Use a mix of interpersonal, community media and mass
media channels to achieve better results rather than use any
single medium
• Different channels should be chosen based on the issue &
target audience to be addressed
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53. Channels Tools Activities / materials
Interpersonal channels
provide for face-to-face
interaction and instant
feedback
Training,
flipcharts,
BCC toolkit,
supervision kit
One-to–one interaction between
health worker and woman,
between ANM, physician and
woman, family; counselling, group
meetings with women, parents-in-
law, community leaders
Community channels
reach a wider audience
within the region and
can be used to change
social norms and create
positive support for
each other’s behaviour
Community
Participation
and
community
media
Community discussions to
garner support of women’s
groups, youth groups, street plays,
community health charts, health
melas, saas bahu melas,
community felicitations and
events
Mass media reachlarge
audience in a shorter
period and can be used
to reinforce messages
Advertising,
advocacy,
health
promotion
Press releases, TV talk shows,
radio shows, CD spots, health
SMS to women, men and
health providers.
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54. Major BCC Initiatives
• Sanitation and Hygiene Program
• Health and environment education
• Nutrition Assessment and Gap Analysis (NAGA) from which a five-
year multisectoral plan for nutrition was prepared. This included
evidence-based interventions for the health, agriculture, education,
WASH and welfare sectors.
• Program for improving newborn and maternal health : Suaahara , a
five year integrated nutrition program for women and children in
Nepal (2011-2016)
• HIV prevention programs
• Malaria control programs and other infectious disease control
programs
• Family planning services
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55. Shape-up Somerville Initiative
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56. Stakeholder involvement
• Cambridge Health Alliance (CHA),
• members of the Tufts University Friedman School of Nutrition
Science and Policy,
• an emerging community health research organization, the
Institute for Community Health (ICH),
• Somerville Public Health Department.
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57. • Researchers from Tufts University received CDC funding for a
Shape Up Somerville intervention, which included
components designed to promote healthy eating and physical
activity for children, at home, at school, and in the
community.
• The primary focus of the grant was on students in grades 1-3
in the Somerville Public Schools.
• GOAL: to influence every part of an early elementary
schoolchild’s day – before, during, and after- school to
promote healthy eating and physical activity and improve
children’s weight status.
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58. • INTERVENTION INCLUDED
• Food service enhancements to improve breakfast and lunch and
staff professional development, food service infrastructure
development, i.e. equipment and facility improvements
• Walk to school activities
• SUS classroom curriculum and professional development
• School wellness policy development
• SUS After-school curriculum and professional development
• Outreach and education to home through materials, forums, events
• “SUS approved” restaurants
• Community outreach and capacity building through policy
development, trainings, media placements.
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59. • SUS After-school curriculum and professional development
• Outreach and education to home through materials, forums,
events
• “SUS approved” restaurants
• Community outreach and capacity building through policy
development, trainings, media placements,
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60. • Researchers from the Institute for Community Health received
funding for “Growing Healthy” to support school-based vegetable
gardens and fruit and vegetable promotion in the school cafeteria.
• GOAL: to increase the consumption of fruits and vegetables by
school-aged children through experiential learning in the
lunchroom and school gardens.
• INTERVENTIONS INCLUDED:
• Developed school-yard gardens and vegetable promotion
curriculum
• Promoted usual and unusual fruits and vegetables through school
food service using taste tests, fruit and vegetable of the month, and
campaign materials
• Outreach and education home through newsletters to parents
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61. • Community applicants from Groundworks Somerville received
funding to support city planning infrastructure and
partnership development to improve walking and biking
opportunities in Somerville.
• GOALS: to improve the infrastructure and capacity of
Somerville to promote physical activity and active living for all
residents through partnership development, programming,
promotion of physical activity and opportunities for activity,
developing policies and physical or “built” environment
supportive of physical activity.
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62. • INTERVENTIONS INCLUDED:
• Advocacy for bicycle and pedestrian changes to the city
• Supporting SUS partnership activities
• Supporting immigrant community organizations active living
activities
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63. Guiding Principals
• First, the SUS community-based initiatives have explicitly
targeted multiple sectors of the community.
• Second, SUS initiatives developed as a result of engaging
community partners in the planning, implementation, and
evaluation of the initiatives.
• This participatory approach to obesity prevention is a key
ingredient to success and sustainability.
• Third, attention to applying theoretical models and evidence-
based approaches has been a hallmark of the SUS approach to
intervention development and achieving sustainability.
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64. • Core to its success has been the political will and leadership of
the city of Somerville to prioritize childhood obesity
prevention and wellness promotion for all Somerville
residents.
• Leadership, engagement and support from the Mayor and
many city departments/ program has been critical to
institutionalization of the SUS mission and values – health is a
priority in Somerville.
• Balance between program evolution and ongoing
maintenance of the core components of SUS initiatives.
• Continued success came from innovative, new and sustained
collaborations.
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65. • Diversified funding allowed for multi-level and multi-sector
initiatives spanning from the school food service to parks and
playgrounds.
• Sustained interest from original SUS developers and
connection to new personnel was critical to maintain
enthusiasm and seek new funding.
• External credibility from academic published articles as well
as national recognition was a key ingredient to sustain
interest, promote progressive thinking, assist in acquiring
additional funding and encourage city level interest across
multiple domains.
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66. • SUS Task Force, Steering Committee, and community
partnerships sustained relationships and a shared agenda.
• Consistent branding and use of social marketing techniques
to increase visibility and exposure to SUS name, logo and
mission statement.
• Strategic placement of questions in community wide surveys;
Consistent reporting of data by research groups and the city
showing positive change was critical to fostering innovation,
identifying gaps/ opportunities, and celebrating successes.
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67. Conclusion
• SBCC is a comprehensive, strategic plan to bring about change
within an individual and in their environment.
• Clear objectives should be set out at the beginning of the
program and focus should be on reaching the target
population.
• When correctly applied SBCC programs can bring a positive
change in the behavior of the individual, the community and
the nation ultimately leading to decreased burden of disease
and promoting a healthy lifestyle.
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68. References
• Park’s textbook of preventive and social medicine, twenty fifth edition
• Oxford Textbook of Public Health, Fifth Edition
• Communication/ Behavior change tools- Programme Briefs by UNFPA
• https://sbccimplementationkits.org/sbcc-in-emergencies/learn-about-sbcc-and-emergencies/what-
is-social-and-behavior-change-communication
• The Elaboration Likelihood Model of persuasion: Developing Health promotions for sustained
behavior change , Richard E. Petty, Jamie Barden S., Christian Wheeler
• Johri M, Chandra D, Kone KG, Sylvestre MP, Mathur AK, Harper S, Nandi A, Social and Behavior
Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen
Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study
• https://healthcommcapacity.org/about/why-social-and-behavior-change-communication/
• https://www.who.int/
• Elder J.P.,et al, ‘Theories and Intervention Approaches to Health-Behaviour Change in Primary Care
• https://www.somervillema.gov/sites/default/files/shape-up-somerville-story.pdf
• https://www.who.int/healthpromotion/social-mobilization
• https://www.hivpolicy.org/Library/HPP000533.pdf
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69. THANK YOU.
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