BEHAVIOUR CHANGE COMMUNICATION AND ATTITUDE TRAINING

Meaning of terms

BEHAVIOR CHANGE INTERVENTION (BCI): A combination of activities/interventions

tailored to the needs of a specific group and developed with that group to help reduce risk
behaviors and vulnerability to HIV by creating an enabling environment for individual and
collective change.
BEHAVIOR CHANGE COMMUNICATION (BCC): An interactive process with
communities (as integrated with an overall program) to develop tailored messages and
approaches using a variety of communication channels to develop positive behaviors; promote
and sustain individual, community and societal behavior change; and maintain appropriate
behaviors.
FORMATIVE BCC ASSESSMENT: Research conducted before the start of a project to help
staff establish target population profiles to be used in developing messages.
GATEKEEPER: A person outside a target audience who has both influence and control over
access to that audience. GOAL: The hoped-for result of a program or project.
INTRAVENOUS DRUG USER (IDU): A person who injects drugs (and thereby raises his or
her risk of HIV infection).
INFORMATION, EDUCATION AND COMMUNICATION (IEC): Development of
communication strategies and support materials, based on formative research and targeted at
influencing behaviors among specific groups.
OBJECTIVE: A specific, measurable and time-bound result.
OPINION LEADER: A person who has great influence over members of a target audience.
PLHIV: Person/s living with HIV/AIDS.
STRATEGIC PLANNING: A disciplined effort to generate fundamental decisions and actions
that will shape and guide the direction of a project or program. Strategic planning is flexible,
often iterative and longrange, covering a period of three to five years. It includes setting the
project’s/program’s goals, strategies and objectives.
STRATEGY: A coordinated and comprehensive plan for guiding multiple actions or activities
that are aimed at achieving a project’s goal and objectives.
STAKEHOLDER: A person or group with an interest in the outcome of an intervention. SEX
WORKER (SW): A person who sells sex in exchange for money, commodities, or services.
TARGET POPULATION: A group within a population who share similar characteristics and
behaviors, and upon whom BCC activities are focused.

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TRADITIONAL MEDIA: Channels of communication that are usually culture- or community-
specific.

INTRODUCTION
Behavior change communication (BCC) is an interactive process with communities (as integrated
with an overall program) to develop tailored messages and approaches using a variety of
communication channels to develop positive behaviors; promote and sustain individual,
community and societal behavior change; and maintain appropriate behaviors. In the context of
the AIDS epidemic, BCC is an essential part of a comprehensive program that includes both
services (medical, social, psychological and spiritual) and commodities (e.g., condoms, needles
and syringes).
Before individuals and communities can reduce their level of risk or change their behaviors, they
must first understand basic facts about HIV and AIDS, adopt key attitudes, learn a set of skills
and be given access to appropriate products and services.
They must also perceive their environment as supporting behavior change and the maintenance of
safe behaviors, as well as supportive of seeking appropriate treatment for prevention, care and
support.
In most parts of the world, HIV is primarily a sexually transmitted infection (STI). Development
of a supportive environment requires national and community-wide discussion of relationships,
sex and sexuality, risk, risk settings, risk behaviors and cultural practices that may increase the
likelihood of HIV transmission. A supportive environment is also one that deals, at the national
and community levels, with stigma, fear and discrimination, as well as with policy and law.
BCC is both an essential component of each program area and the glue between the various areas.
However, society-wide change is slow; changes achieved through BCC will not occur overnight.

THE ROLE OF BEHAVIOR CHANGE COMMUNICATION

BCC is an integral component of a comprehensive HIV/AIDS prevention, care and support

program. It has a number of different but interrelated roles. Effective BCC can:
1. Increase knowledge. BCC can ensure that people are given the basic facts about HIV and
AIDS in a language or visual medium (or any other medium that they can understand and
relate to).
2. Stimulate community dialogue. BCC can encourage community and national discussions
on the basic facts of HIV/AIDS and the underlying factors that contribute to the epidemic,
such as risk behaviors and risk settings, environments and cultural practices related to sex

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 and sexuality, and marginalized practices (such as drug use) that create these conditions.
It can also stimulate discussion of healthcareseeking behaviors for prevention, care and
support.
3. Promote essential attitude change. BCC can lead to appropriate attitudinal changes about,
for example, perceived personal risk of HIV infection, belief in the right to and
responsibility for safe practices and health supporting services, compassionate and non-
judgmental provision of services, greater open-mindedness concerning gender roles and
increasing the basic rights of those vulnerable to and affected by HIV and AIDS.
4. Reduce stigma and discrimination. Communication about HIV prevention and AIDS
mitigation should address stigma and discrimination and attempt to influence social
responses to them (see box).
5. Create a demand for information and services. BCC can spur individuals and communities
to demand information on HIV/AIDS and appropriate services.
6. Advocate. BCC can lead policymakers and opinion leaders toward effective approaches to
the epidemic.
7. Promote services for prevention, care and support. BCC can promote services for STIs,
intravenous drug users (IDUs), orphans and vulnerable children (OVCs); voluntary
counseling and testing (VCT) for mother-to-child transmission (MTCT); support groups
for PLHA; clinical care for opportunistic infections; and social and economic support.
BCC is also an integral component of these services.
8. Improve skills and sense of self-efficacy. BCC programs can focus on teaching or
reinforcing new skills and behaviors, such as condom use, negotiating safer sex and safe
injecting practices. It can contribute to development of a sense of confidence in making
and acting on decisions.

THE PROCESS OF BEHAVIOR CHANGE:

STEPS TO BEHAVIOR CHANGE
These are the ideal steps one follows towards behavior change. They may apply to health workers
or community members
 Knowledge:
• One first learns about a new behavior
• Recalls messages and understands meaning of the messages
• Can name strategies and practices
 Approval:
 One then approves of the new behavior
 Responds favorably to messages
 Discusses the information with personal network (professional, colleagues, family and friends)
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 Thinks professional colleagues, family, friends and community approves of practices
 Intention:
 One then believes this behavior is beneficial to them and intends to adopt it
 Recognizes that behavior change strategies can meet a personal health and nutritional need
 Intends to adopt the agreed practices
 Practice:
 One then attempts new behavior and continues to practice Advocacy
 One can then promote the new behavior through their social or professional networks as a
satisfied practitioner
 Experiences and acknowledges personal benefits of adopting behaviors that enhance health

BCC GOALS
Behavior change communication goals need to be developed in the context of overall program
goals and specific behavior change goals. The following highlights the place of BCC goals within
an overall program.
Program goal: Reduce HIV prevalence among young people in urban settings in X country.
Behavior change goals:
1. Increase condom use
2. Increase appropriate STI care-seeking behavior
3. Delay sexual debut
4. Reduce number of partners
5. Increase perception of risk or change attitudes toward use of condoms
6. Increase demand for services
7. Create demand for information on HIV and AIDS y Create demand for appropriate STI
services
8. Interest policymakers in investing in youth-friendly VCT services (services must be in
place)
9. Promote acceptance among communities of youth sexuality and the value of reproductive
health services for youth (services must be in place)
10. BCC goals are related to specific issues identified when assessing the situation,
knowledge, attitudes and skills that may need to be changed to work toward behavior
change and program goals.

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GUIDING PRINCIPLES
1. BCC should be integrated with program goals from the start. BCC is an essential element
of HIV prevention, care and support programs, providing critical linkages to other
program components, including policy initiatives.
2. Formative BCC assessments must be conducted to improve understanding of the needs of
target populations, as well as of the barriers to and supports for behavior change that their
members face (along with other populations, such as stakeholders, service providers and
community).
3. The target population should participate in all phases of BCC development and in much
of implementation.
4. Stakeholders need to be involved from the design stage.
5. Having a variety of linked communication channels is more effective than relying on one
specific one.
6. Pre-testing is essential for developing effective BCC materials.
7. Planning for monitoring and evaluation should be part of the design of any BCC program.
8. BCC strategies should be positive and action-oriented.
9. PLHA should be involved in BCC planning and implementation.