1.

Behavior Change Communication

Behavior Change Communication (BCC) is a process of any intervention with individuals,

communities and/or societies to develop communication strategies to promote positive behaviors
which are appropriate to their settings. This in turn provides a supportive environment which will
enable people to initiate and sustain positive and desirable behavior outcomes.

BCC should not be confused with behavior modification, a term with specific meaning in a
clinical psychiatry setting.

Background

Providing people with information and teaching them how should they behave does not lead
to desirable change in there response/behavior. However, when there is a supportive environment
with information and communication (teaching) then there is a desirable change in the behavior of
the target group. Thus, Behavior Change Communication is proved to be an instructional
intervention which has a close interface with education and communication. It is a strategic and
group oriented form of communication to perceive a desired change in behavior of target group.

Behavior Change Communication strategies

Behavior Change Communication is different from ordinary instructional method of

communication and is target specific. A society consists of many sub-groups. The strategy for
Behavior Change Communication will vary from group to group. Following points are important
while considering the Behavior Change Communication strategy.

Vulnerability/risk factor of the target group.

The Vulnerability/risk factor of the group which is to addressed.

The conflict and obstacles in the way to desired change in Behavior.

Type of message and communication media which can best reached to target group.

Type of resources available and assessment of existing knowledge of the target group about the
issue which is going to dealt.

There can be several more points in this list. A successful Behavior Change Communication
requires lots of research and meticulous planning about the knowledge content of the subject and
behavior/attitude pattern of the target group.
Implications of Behavior Change Communication

Behavior Change Communication is an effective tool for dealing many community and group
related problems. BCC has been adapted as an effective strategy for Community Mobilization, health
and environment education and various public outreach programs. Enhanced knowledge about the
behavior change process has facilitated the design of communications programs to reduce the risk of
HIV transmission and AIDS. A wide variety of health promotion strategies use communication as
either an educational or norm-forming strategy. In addition, specific strategies must be designed for
high-risk groups such as women, young people, injecting drug abusers, homosexuals and HIV
positive groups.

2. Strategic Behavioral Communication (SBC)

Strategic behavioral communications (SBC), the FHI 360 brand of behavior change
communication, is the integration of marketing principles and behavioral and social science. With an
evidence-based theoretical foundation grounded in behavioral science, SBC utilizes best practices
from the commercial marketing sector and integrates a number of key marketing principles,
including a consumer focus where beneficiaries are a crucial part of the process; the exchange
theory, which recognizes that change involves giving up a current behavior in exchange for another;
and the marketing mix, which goes beyond promotion to designing strategies that make healthy
choices easier choices.

FHI 360 applies SBC across all of its public health programs, from HIV/AIDS prevention and
treatment to reproductive health and other infectious and chronic diseases. The goal is to increase
knowledge, shift attitudes, and ultimately impact behavior. SBC drives environmental as well as
individual change in an effort to create enabling environments that make health-seeking and low-
risk behaviors achievable.

SBC is a participatory, collaborative process where FHI 360 behavioral scientists work closely with
communication and creative experts in over 40 countries to develop behavior change interventions
that bring together the power of art, the accuracy of science, and the relevance of local cultural
values and traditions. To ensure innovation and impact in all of its behavior change programming,
FHI 360 utilizes proprietary planning tools and quality criteria from inception to evaluation.

The essentials of IEC

Information, education and communication (IEC) combines strategies, approaches and

methods that enable individuals, families, groups, organisations and communities to play active roles
in achieving, protecting and sustaining their own health. Embodied in IEC is the process of learning
that empowers people to make decisions, modify behaviours and change social conditions. Activities
are developed based upon needs assessments, sound educational principles, and periodic evaluation
using a clear set of goals and objectives. IEC activities should never be developed or implemented
independently from a broader reproductive health programme that is being designed and executed
in the country. IEC activities not only need to have an appropriate context in which they are shaped,
but it is crucial that health services providers be prepared to respond to any demand that may be
created as a result of effective IEC activities. The influence of underlying social, cultural, economic
and environmental conditions on health are also taken into consideration in the IEC processes.
Identifying and promoting specific behaviours that are desirable are usually the objectives of IEC
efforts. Behaviours are usually affected by many factors including the most urgent needs of the
target population and the risks people perceive in continuing their current behaviours or in changing
to different behaviours.

Health information can be communicated through many channels to increase awareness

and assess the knowledge of different populations about various issues, products and behaviours.
Channels might include interpersonal communication (such as individual discussions, counselling
sessions or group discussions and community meetings and events) or mass media communication
(such as radio, television and other forms of one-way communication, such as brochures, leaflets
and posters, visual and audio visual presentations and some forms of electronic communication).

Good communication between users and providers of any service is essential; but it is
especially important when providing RH services, given the sensitive nature of some of the issues
that are addressed (such as sexual violence, female genital mutilation, and providing contraceptives
to adolescents). Accordingly, IEC approaches must be carefully and appropriately designed and
selected.

Although good "one-to-one" communication at the point of service provision is essential for
transmitting information and building trust with the client, communication with other individuals
and groups within the community is also vital. It is through such communication networks that
service providers can obtain information about users' needs, priorities and concerns. Such informal
information gathering is the first step in assessing needs (which can be supplemented by other more
formal means – see section below). It also helps providers better understand the specific setting and
context in which they are working, which will be useful in the later development of IEC approaches,
messages and materials.
 These types of conversations, or passing on information by "word-of-mouth", has been
shown to be one of the most effective communication channels for acquiring knowledge and
promoting desired changes in behaviour. Evidence of this is the speed with which rumours spread
and the force of their impact. Field staff should not ignore these informal opportunities to educate
the public through casual conversation with people in the community.

Once a refugee situation stabilises, it becomes appropriate to consider the development of

more elaborate and formal IEC strategies. This requires serious thought and significant allocation of
time and resources. The steps involved in the development of IEC are outlined here, but this is not
intended to be an exhaustive guide. More in-depth information and details can be found in the items
listed in Further Reading. Whatever materials and formal programmes are developed, it is important
to ensure that the different aspects are coordinated, and that the content of any messages and the
media used to convey those messages are complementary. It is also vital to ensure that people are
provided with the necessary support and resources to act in the manner advised.

Communication

Communication can be both verbal and non-verbal.

In verbal communication, the tone of voice can communicate feelings and emotions that are
as significant as the words being spoken. Accordingly, it is important to choose words that do not
offend in any way and that are easily understood. One should avoid using trigger words, jargon,
medical or other sophisticated terms. The use of particular languages may be important in reaching
all sections of a community (women may speak fewer languages than men, for example).

In non-verbal communication, body position, gestures and facial expression, often referred
to as "body language", can communicate as much as words. It is often through such body language
that we express our attitudes towards an issue, a person or a person's behaviour. Service providers
must become skilled in interpreting the body language of users as this may assist them in
understanding users' needs and concerns more fully. Service providers must also be aware of their
own body language and the signals they may be unknowingly sending to users (e. g., movements or
expressions that indicate fatigue, boredom, fear, frustration, indecision). It is important that the
attitude conveyed by the service provider be compassionate and non-judgmental.

Service Users

Good communication skills are necessary to ensure that good-quality services are provided
and that service users are satisfied. It is through communication that trust and rapport are
established between the provider and user of a service. Emotional support and the communication
of concern and understanding by health staff are often as crucial in providing quality services as is
clinical care. If there is a strong provider-user relationship established in this way, it becomes easier
to move towards open dialogue on more sensitive aspects of reproductive health.

Other Individuals and Community Groups

Beyond communication with service users, it is necessary to open a dialogue with influential
individuals and groups within the community. Such individuals and groups will need to be identified
as early as possible. The nature and intention of services should be explained to them and their
concerns and priorities discovered and understood. This will not only help make the services more
appropriate to the clientele being served, but it will help garner family and community support for
the client in the reproductive health behaviour being promoted. The following are some pointers for
identifying such individuals and groups:

Familiarise yourself with the community with the help of someone who lives in the
environment of the refugees and who provides them with some service, advice or protection.

Identify individuals who are most important in the social structure of the community with
which you are working. They can be existing formal leaders (elected or appointed), but, more often
than not, they are informal leaders. This can be done by asking many people in the community. As
certain individuals are named repeatedly, it will become clear that they are the true leaders.

Identify individuals who have some influence within the community, people whose opinions
are respected. They will make suggestions about how to approach people and work with them
effectively. They can also serve as role models for desired behaviours and actions.

Provide these individuals with very clear information about what your intentions are, what
you plan to do, and how they can contribute as partners. Be specific about what they will gain from
working with you and allowing you access to the community.

Provide them with input about your plans before you proceed, and secure their willingness to
participate and to support your efforts.

3. Konsep Perilaku dan Perilaku Kesehatan

Dua Jenis Respons (Skiner, 1938)

1. Respondent Respons / Refkelsif  Respons yang ditimbulkan oleh stimulus tertentu (Elicting
Stimuli)

2. Operant Respons / Instrumental Respons  Respons yang timbul & berkembang kemudian
diikuti oleh stimuli yg lain

Teori S-O-R (Skiner, 1938)  Perilaku dikelompokkan :

1. Covert Behavior (Perilaku Tertutup)  Apabila respons terhadap stimulus masih belum
dapat diamati

2. Overt Bahavior (Perilaku Terbuka)  Apabila respons terhadap stimulus dapat diamati
(obsevable behavior)
ILMU-ILMU DASAR PERILAKU

PERILAKU KESEHATAN ( Healthy Behavior )

Adalah : Respons seseorang terhadap stimulus atau objek yg berkaitan  Sehat – Sakit, Penyakit,
Faktor yg mempengaruhi Kesehatan

Klasifikasi Perilaku Kesehatan (Becker, 1979) :

1. Healthy Behavior  aktivitas yang berkaitan dengan upaya mempertahankan &

meningkatkan kesehatan

2. Illness Behavior  aktivitas seseorang / keluarganya yang sakit dan/atau terkena masalah
kesehatan untuk mengatasinya

3. The Sick Role Behavior  orang sakit punya peran (role), hak (rights) & kewajiban
(obligation)
DOMAIN PERILAKU (Bloom, 1908) :

PENGUKURAN & INDIKATOR PERILAKU KESEHATAN

1. Health Knowledges  pengetahuan tentangg cara-cara memelihara kesehatan

2. Health Attitude  pendapat/penilaian terhadap hal-hal yg berkaitan pemeliharaan

kesehatan

3. Health Practice  kegiatan / aktivitas dalam rangka memelihara kesehatannya

Tahap-Tahap Kegiatan dlm Perubahan Perilaku (Hanlon, 1964)

1. Tahap Sensitisasi

2. Tahap Publisitas

3. Tahap Edukasi

4. Tahap Motivasi

Promosi Kesehatan dan Perilaku

Upaya Intervensi terhadap Faktor Perilaku melalui pendekatan :

a. Pendidikan ( Education )

b. Paksaan atau Tekanan ( Coercion )

Hubungan Promosi Kesehatan dengan Determinan Perilaku