Social and Behavior Change Communication (SBCC): Resources on Theory and its Application Image credit: Adapted from McKee, Manoncourt, Chin and Carnegie (2000) Over the past year, we have noted that many of you come to the C-Capacity website searching for resources on social and behavior change communication (SBCC) theories, models and approaches. Theories and models are essential for program planning; they offer conceptual tools that have been developed and refined over many years of empirical study that can guide the development of new interventions and strategies. Theories and models can help us formulate objectives as well as measurement indicators for behavior and social change interventions. The socio-ecological model (see graphic at left) is based on existing theories, models, and approaches from several disciplines, including political science, education, sociology, psychology, and communication. Through a synthesis of the information included in these theories and approaches, the socio-ecological model proposes several levels, or "layers," of influence to find effective tippin! g points for change. The resources on theory in this issue of C-Capacity are organized by these levels of influence: individual, interpersonal, community/social, and enabling environment. While this issue does not provide a complete or standard list of theories, models and approaches, the core resources below are both thought-provoking and part of current discussions in SBCC.

News C-Change Conducts SBCC Refresher Training with Partners in Southern Africa Jobs Health Systems Specialist - USAID - Abidjan, Cote D'Ivoire International Research Manager - InterMedia Survey Institute - Washington, DC, USA Worth Reading Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy Connect Positive Deviance (PD)/Basic Guide to the Positive Deviance (PD) Approach Talking About Theory and Practice Blog Entry Core Resources Theory at a Glance: A Guide for Health Promotion Practice Family Tree of Theories, Methodologies and Strategies in Development Communication: Convergences and Differences

Core Resources... Gender-Specific HIV Prevention with Urban Early-Adolescent Girls: Outcomes of the Keeping' It Safe Program The Role of Theory in Developing Effective Health Communications The Relevance of Client-Centered Communication to Family Planning Settings in Developing Countries: Lessons from the Egyptian Experience Facilitating Behavior Change with Low-Literacy Patient Education Materials Culturally Compelling Strategies for B! ehaviour Change: A Social Ecology Model and Case Study in Malaria Behavioural Economics: Seven Principles for Policy Makers Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory What Complexity Science Teaches Us About Social Change Explication of Social Norms Further Journal Reading A list of articles for those interested in exploring this topic further Training C-Modules Course on Social and Behaviour Change Communication (SBCC) Achieving Millennium Development Goal 5: Reproductive Health, Poverty Reduction and Health System Strengthening

About C-Capacity

C-Capacity is an e-magazine supported by C-Change and prepared by The Communication Initiative in cooperation with C-Change partner Ohio University. It is dedicated to alerting you and your organization to resources, training, links, and other opportunities for capacity strengthening in social and behavior change communication (SBCC), all vetted for quality and relevance by FHI 360 and Ohio University.

The C-Capacity Online Resource Center is a living resource designed to provide the best resources and training opportunities available and we welcome your contribution. We are looking for case studies, strategic thinking, support materials, trainings, meetings, and other resources relevant to SBCC capacity strengthening. To contribute, please contact cchangeorc@comminit.com

C-Change Capacity Strengthening News

1.C-Change Conducts SBCC Refresher Training with Partners in Southern Africa

C-Change facilitated a refresher training on SBCC with 21 partners from the Southern Africa AIDS Trust (SAT) network in October 2011. The refresher was the final training in a series of four and focused on key concepts in the C-Modules and facilitation skills. C-Change has been working with the SAT and their network of community-based organizations since 2010 to increase skills and competencies in SBCC through face-to-face trainings, technical assistance, and mentoring. The group of 21 trained SBCC practitioners will play a central role in using SBCC to strengthen their existing programs and introduce SBCC to the other SAT partners within their country networks.

[Return To Top]
 

C-Channel is an e-newsletter produced by C-Change that showcases the impact of social and behavior change communication (SBCC) by presenting a selection of current, peer-reviewed journal articles about SBCC around family planning, reproductive health, HIV prevention, malaria prevention and control, and social and gender norms. C-Channel makes abstracts and full journal articles available free of charge to readers in the developing world, via email. See Issue 36 - More Peer-Reviewed Articles on Adapting SBCC Programs and Activities for more information. To subscribe, please go to the C-Channel main page and follow the instructions in the right column.

Jobs

2. Health Systems Specialist - USAID - Abidjan, Cote D'Ivoire

The Health Systems Specialist functions as Chief of the PEPFAR Cote D'Ivoire Health Systems Strengthening (HSS) Branch (office) and will assist PEPFAR CI to transition from an emergency to a more sustainable country program. S/he is one of six senior-level specialists/Branch Chiefs and reports directly to the USAID PEPFAR Country Director. The incumbent will design and oversee implementation of health sector reform and related systems strengthening activities to be supported under the PEPFAR CI program. Such activities aim to reinforce basic systems, practices and tools that are necessary for optimal institutional performance, improved health outcomes, and sustainable programs.

3. International Research Manager - InterMedia Survey Institute - Washington, USA

InterMedia is seeking an experienced International Research Manager with a verifiable track record of designing and delivering quantitative and qualitative research in developing countries. Candidates will need to have proven experience of effectively managing multi-country research studies and, ideally, will have applied knowledge in the field of financial access and financial services that are available to people at the bottom of the pyramid across the globe ñ often through mobile phones.

[Return To Top]

Worth Reading

4. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy

As cited in C-Change C-Channel issue 32, article #2, "[t]he Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published.

....The purpose of this article is to propose a model to help guide future Internet! intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions ....By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established."

[Return To Top]

Connect

Select Forums and Communities

5. Positive Deviance (PD)/Basic Guide to the Positive Deviance (PD) Approach

The Positive Deviance (PD) Initiative is an organization dedicated to the documenting, sharing, and promoting of the "positive deviance approach" to solving social problems. Positive deviance is a behavior and social change approach that views communities as holders of solutions to their own problems. This guide is written to explain the PD approach, which seeks to identify and optimize existing successful solutions or strategies within a community or organization in order to solve problems that require behavior and social change. The PD Initiative provides resources, case studies, and guidance for getting started on their website, as well as a monthly newsletter.

6. Talking About Theory and Practice Blog Entry

This is a blog by Silvio Waisbord, Associate Professor in the School of Media and Public Affairs at George Washington University, Washington, DC, United States. This post raises questions about the dialogue and collaboration between academics and practitioners in development work. Although it recognizes that conversations across institutions do happen, Waisbord thinks that interest is limited because each "community of practice" is driven by different sets of questions. The challenge, then, becomes identifying common issues and avoiding the typical opposition between theory and practice.

[Return To Top]

Select Core Resources: Theory and Application

Below you will find a selection of core resources on SBCC theory, models and approaches. A full list can be found in the C-Modules. The core resources are organized into four categories: general, individual, interpersonal, and community/social. The general theories are comprised of several different theories.

Multiple Theories:

7. Theory at a Glance: A Guide for Health Promotion Practice

This is the 2005 edition of a book on behavior change theories, processes, and environmental and common factors that influence behavior as it relates to health. The aim of this guide is to improve the effect of public health workers and to analyze the motives of success or failure of final programs. It presents tools for the resolution of problems in the field of health promotion.

This publication is comprised of: 1) Foundations of Theory in Health Promotion and Health Behavior - includes the "basics" to apply theory to the practice of health promotion, addresses the way in which theory and models can be useful in practice of health promotion and provides basic definitions and the context; and 2) Theories and Applications - begins with the presentation of an ecological perspective of the programs of health promotion and then describes several theories or models of individual and interpersonal behavior. Each theory is presented as a possible method of solving a practical problem. Subsequently, a brief description is presented, as are fundamental definitions of concepts and additional examples or case studies. Finally, 3) Putting Theory and Practice Together - identifies different processes of integration - explains how theories can be used in planning, execution and promotion of health programs.

[Return To Top]

8. Family Tree of Theories, Methodologies and Strategies in Development Communication: Convergences and Differences

This paper explores the roots and shape of the field of development communication. In it, Silvio Waisbord presents readers with a "family tree" of theories, concepts, methodologies and strategies for change, describing each "offshoot" of the related but quite distinct directions in which this field has moved - from its origins in post-war international aid programs in developing countries to its various refinements over the years, through to the present day. In short, this report "identifies the main theoretical approaches and their practical applications, traces their origins, draws comparisons, and indicates strengths and weaknesses. It also analyzes the main understandings of development communication that express the outlook of the main 'trunks' and 'branches' of the family tree."

[Return To Top]

Focus on the Individual Level:

9. Gender-Specific HIV Prevention with Urban Early-Adolescent Girls: Outcomes of the Keeping' It Safe Program

Published in 2007, this study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls in the United States. The program is based on the AIDS risk reduction model (ARRM), a 3-stage model of harm reduction that integrates concepts from the health belief model, the theory of reasoned action, the theory of planned behavior, self-efficacy theory, emotional influences, and interpersonal processes. According to the ARRM, to avoid HIV infection, individuals engaging in sexual risk behaviors must perceive their actions as problematic (the so-called "labeling" stage), commit to changing the behaviors (the "commitment" stage), and take action to do so (the "action" stage).

[Return To Top]

10. The Role of Theory in Developing Effective Health Communications

The purpose of this study was to demonstrate the relevance of behavioral theory for the design of communication to promote healthy behaviors. Using data from a study on smokers' intentions to quit or continue smoking, the authors show how theory helps to identify key beliefs that underlie people's intentions (to quit or not to quit). Final arguments describe the limitations of behavioral theory: While behavioral theory can help identify beliefs that should be targeted with persuasive communication, practitioners' ability to change these beliefs will need support from communication theory to find out how to communicate effectively.

[Return To Top]

Focus on the Interpersonal Level:

11. The Relevance of Client-Centered Communication to Family Planning Settings in Developing Countries: Lessons from the Egyptian Experience

From the Abstract: "The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews."

[Return To Top]

12. Facilitating Behavior Change with Low-Literacy Patient Education Materials

This 2007 article describes a process for developing low-literacy health education materials that are designed to increase patients' knowledge and motivate them to adopt healthier behaviors. The authors illustrate this process by describing the development of a printed diabetes self-management guide in the United States; however, many of the principles are also applicable to web-based, telephone, and other interactive health education innovations.

As noted here, all health behavior theories consider adequate knowledge of the benefits of healthy behaviors to be a prerequisite for behavior change. Another concept is that of self-efficacy, which in the health care context refers to one's confidence in successfully organizing and executing the courses of action necessary to manage one's health care needs - for example, adhering to a diabetic diet. Furthermore, social cognitive theory suggests that patient education materials designed to activate patients toward healthier behaviors ought to: improve knowledge of the health effects of behavior change; positively influence outcome expectations; emphasize behavior change for facilitators; address impediments to behavior change; and enable the creation and achievement of short-term goals.

[Return To Top]

Focus on the Community/Social Level:

13. Culturally Compelling Strategies for Behaviour Change: A Social Ecology Model and Case Study in Malaria

In this paper, the authors "propose a social ecology perspective to make explicit the links between intention to change, actual behavior change, and subsequent health impact, as relating to both theory-based models and practical strategies for triggering change. A social ecology model focuses attention on the contexts of behavior when designing, implementing or critically evaluating interventions. As a case study, the authors reflect on a community-directed intervention in rural Gambia designed to reduce malaria by promoting a relatively simple and low-cost behavior: repairing holes in mosquito bednets. In phase 1, contextual information on bednet usage, transactions and repairs (the "social lives" of nets) was documented. In phase 2 (intervention), songs were composed and posters displayed by community members to encourage repairs, creating a sense of ownership and a compelling medium for the transmission of health messages. In ph! ase 3 (evaluation), qualitative and quantitative data showed that household responses were particularly rapid and extensive, with significant increase in bednet repairs (po0:001), despite considerable constraints on human agency. We highlight a promising approach - using songs - as a vehicle for change, and present a framework to embed the design, implementation and critical evaluation of interventions within the larger context - or social ecology - of behavior practices that are the bedrock of health interventions."

[Return To Top]

14. Behavioural Economics: Seven Principles for Policy Makers

From the new economics foundation (nef): This briefing distills concepts from behavioral economics and psychology down to seven key principles intended to highlight the main shortfalls in the neoclassical model of human behavior. The authors aim to change the analytical framework for policy as well as to maximize the impact of policy interventions, as well as reduce unintended outcomes arising from making decisions based solely on a neoclassical economic analysis.

[Return To Top]

15. Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory

This working paper, published by the United Nations Children's Fund (UNICEF) Innocenti Research Centre, discusses the application of the social convention theory to the practice of female genital mutilation/ cutting (FGM/C). The theory compares footbinding in China to FGM/C in Africa, explains each practice in terms of simple game theory, and recommends that the methods that were used to end footbinding be adapted to end FGM/C.

[Return To Top]

16. What Complexity Science Teaches Us About Social Change

In this article, the traditional frameworks for measurement of social change and development intervention outcomes are questioned. The author, Virginia Lacayo asserts that, "[s]eldom do such methods and indicators reveal the multilevel mechanisms through which social change occurs." Using her work with the Nicaraguan organization Puntos de Encuentro as a case study, Lacayo challenges traditional development planning and research methods based on behavior change communication theories and used by scholars and grantors, resulting in a hegemonic, linear model. She describes her search for a nonlinear, complex, and holistic model that legitimately captures the process of social change in ways that lead to "revamped field-based interventions."

Lacayo looks to complexity literature, which has a framework used to analyze interactions between various actors in systems, such as stock markets, human bodies, forest ecosystems, manufacturing businesses, and hospitals, as complex adaptive systems (CAS). She describes complexity science as seeking to understand how CAS work with regard to the patterns of relationships within them, how they are sustained, how they self-organize and how outcomes emerge.

[Return To Top]

17. Explication of Social Norms

The purpose of this article is to explore the intersection between social norms and communication. It does that by distinguishing the different meanings of social norms, addressing the role of moderators between norms and behaviors, and highlighting attributes of behaviors that determine their susceptibility to normative influences. The article distinguishes between perceived and collective norms and between descriptive and injunctive norms.

[Return To Top]

Subscribe to the C-Picks SBCC E-magazine

The C-Picks e-magazine, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behavior change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).

Subscribe online.

Training

Select Opportunities

18. C-Modules Course on Social and Behaviour Change Communication (SBCC)

Date: Ongoing

Location: Online

C-Change and Ohio University launched the online C-Modules course on social and behavior change communication (SBCC) in two versions - self-paced and facilitated. Available at no cost to participants, the self-paced course is designed for journalists, researchers, students, and government and non-governmental organisation (NGO) health and development practitioners. The goal of the 6-module course is to develop and strengthen competencies in the planning, implementation, and monitoring and evaluation of SBCC activities.

In the self-paced modules, participants work at their own pace to complete units by answering a series of questions, based on the materials and resources provided. Thus, this is a flexible option; individuals can register on their own and are not tied to specific deadlines.

[Return To Top]

19. Achieving Millennium Development Goal 5: Reproductive Health, Poverty Reduction and Health System Strengthening

Date: February 27 ñ March 2 2012