2. Beyond Dialogue: Moving Toward Change of Behavior
Strategic Behavior Change Communication
in Public Health
Beyond Dialogue: Moving Toward Change of Behavior
DR G U AHSAN
Chairman
NORTH SOUTH UNIVERSITY

3. A predictive model of communication & change:
Influence of ideational elements on behavior
Knowledge
Implies simultaneous effect of all influences.
Personal Advocacy
Attitudes
Social Influence
Self-Image
BEHAVIOR
Perceived Risk
Emotion
Self-Efficacy
Norms
Center for Communication Programs
U N I V E R S I T Y
OHNS HOPKINS J
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4. A Generation Ago . . . . Monologue: The “Medical Era”
Expert (sender) sending messages to non-expert (receiver)

5. Doctor speaking to patients
BCC Dr GU Ahsan

6. Moving from monologue to dialogue (both-way)
The 70s: “Field Era”
Moving from monologue to dialogue (both-way)

7. The 70s: “Field Era” • Need to reach people beyond the clinics
• Derived from extension agent approach in agriculture
• Field work supported by IEC materials, films and audio visuals
• Mass media impact on behavior considered modest due to limited reach
• Large volume IEC
• SMCR(E) as dominant communication model

8. The 80s: “Social Marketing Era”
Moving from non-paying clients to customers who ask and pay

9. Moving from dialogue to mutual adjustment and convergence
The 90s to Present: “Strategic Era”
Moving from dialogue to mutual adjustment and convergence

10. The 90s to Present: “Strategic Era”
On the process side
• Participants in the communication process create and share together
• Distinction between “senders” and “receivers” begin to disappear
• Communication not as a spare wheel

11. The 90s to Present: “Strategic Era”
• Greater multi-channel integration
• Multiplicity of stakeholders
• Increased attention to evaluation and evidence- based programming
• Increased sophistication in audience segmentation
• Large scale impact at national and local level
• Role of electronic media more pervasive

12. Developing World Radio and TV Receivers
2100
1800
Radio
1500
Television
1200
Thousands of Receivers
900
600
300
1955
1965
1975
1985
1995
2000
Year
Source: International Broadcasting Audience Research Library/ British Broadcasting Company, 1996.

13. Strategic Communication Today
Strategic communication is a process carried out with the active participation of stakeholders and beneficiaries that addresses a long-term vision and affects the causes of as well as the barriers to behavior change.

14. Strategic Communication Today
Strategic communication includes many approaches such as: community mobilization, client-centered counseling, social network interventions, social marketing, entertainment-education, TV/radio spots, dramas and music, provider promotion, behavior change communication, public policy advocacy, media advocacy, personal and community empowerment, public relations, mass media dissemination...

15. 12 Key Elements of Strategic Communication: Making Evaluation More Complex
Results-oriented
Science-based
Client-centered
Participatory
Benefit-oriented
Service-linked
Multi-channeled
Technically high quality
Advocacy-related
Expanding to scale
Programmatically sustainable
Cost-effective

16. Strategic Directions in HIV/AIDS Behavior Change Communication
More applications of theory-driven communication and behavior change at multiple levels

17. Theory Driven Behavior Change Communication
Ideation is defined as new ways of thinking and the spread of those ways of thinking by means of communication and social interaction in local, culturally homogeneous communities.
Cleland & Wilson, 1987

18. Ideational Factors Related to Condom Use (Zambia)
• Perceives self to be at a moderate-to-high risk of contracting HIV/AIDS
• Knows at least three ways to protect self from HIV/AIDS
• Has talked with at least three people about safe sex
• Has a positive attitude towards people who use condoms
• Knows where to purchase condoms
• Has an above-average sense of efficacy regarding ability to use condoms even when facing opposition from partner

19. Cumulative Effect of Ideational Factors on Condom Use among Male Adolescents, Zambia 2000

20. Cumulative Effect of Ideational Factors on Condom Use among Female Adolescents, Zambia 2000

21. Odds of Condom Use by Ideation and Exposure, Zambia Youth Survey, 2000
Controlling for TV use, sex, age, educational attainment, residence

22. Theory Driven Behavior Change Communication
Ideation
Need to Identify causal (proven) factors related to desired behaviors
• Abstinence
• Being faithful to one partner
• Consistent condom use
• Delaying sexual debut
• Seeking treatment for STIs
• Seeking VCT (Voluntary Counseling and Testing)
• Preventing MTCT (Mother-to Child transmission)

23. Theory Driven Behavior Change Communication
Social acceptance: improving social environment
• Breaking the silence
• Improving policy environment/strengthening political will
• Overcoming stigma
• Agenda priority setting
• Increasing public understanding of HIV impact

24. Theory Driven Behavior Change Communication
Social network
• Stimulating couple & community discussions
• Influencing community norms
• Developing community capacities

25. Theory Driven Behavior Change Communication
Social learning/modeling
• Modeling individual and collective self- efficacy
• Modeling health provider behaviors
• Scaling up Enter-educate (education through entertainment) programming

26. The Individual - Social Continuum HIV/AIDS - related behaviors
Collective Behavior
Change
Individual Behavior
Change
Couple
Community
(e.g.) Consistent
condom use
(e.g.) Reducing
stigma
HIV/AIDS - related behaviors
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27. Indicators for Community Empowerment and Change
Leadership
Degree & Equity of Participation
Information Equity
Collective Self-Efficacy
Sense of Ownership
Social Cohesion
Social Norms
Adapted from draft Rockefeller/JHU document

28. Zambia Nicaragua Uganda Ghana
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29. THANK YOU VERY MUCH