Participants Manual: I.E.C Material Development Training

I.E.
C MATERIAL DEVELOPMENT TRAINING
PARTICIPANTS MANUAL
StrategicBehavioral Commuication Training Handout
TABLE OF CONTENTS
Understanding the Peer concept ..........................................................................................................................5

Rationale for Peer Education .................................................................................................................................6
Theoretical base for Peer Eduaction ...................................................................................................................7
Harvesting, sorting and analysing questions from Peers and Peer Educators ................................ 10
Behavior Change Communication (B.C.C) Strategy .................................................................................... 14
The Strategic Role of Behavior Change Communication .......................................................................... 14
Summary of Behavior Change Theories.......................................................................................................... 15
Setting Program, & Behaviour Change Communication (B,C,C) ............................................................ 16
Essential Steps to develop a Behavior Change Communication Strategy .......................................... 18
Towards Strategic Behavioral Communication, more than just B.C.C ................................................ 19
What is S.B.C? ............................................................................................................................................................ 20
SBC’s Guiding Principles ....................................................................................................................................... 20
Redefining Behavior Change ............................................................................................................................... 21
What Can SBC Do For HIV & AIDS Programs? .............................................................................................. 21
Developing S.B.C Interventions: A 12-Step Approach .............................................................................. 22
Linking Behavioral and Communication Objectives .................................................................................. 24
Linking Strategic Communication Components to Program Goals ...................................................... 25
Choosing the Right Combination of Channels............................................................................................... 26
I.E.C Material Production Guidelines ............................................................................................................... 27
Section 2: Selecting the Most Appropriate IEC Material........................................................................... 28
Guidelines for Selecting IEC Materials ............................................................................................................. 31
Section 3: Developing a Creative Brief ............................................................................................................ 33
Section 4: Preparing draft / prototype I.E.C material (or adapting existing materials) ............... 34
Guidelines for developing new I.E.C materials, or selecting / adapting ............................................. 35
existing I.E.C materials........................................................................................................................................... 35
Section 5: Pretesting Draft / Prototype or Adapted IEC Materials ....................................................... 38
Section 6: Assessing Pre -Test results and revising I.E.C materials ..................................................... 42
Section 7: Monitoring & Evaluating The HIV & AIDS Program .............................................................. 44
Monitoring the use and impact of I.E.C materials ....................................................................................... 47
SAMPLE ICE BREAKERS & INTRODUCTORY GAMES ................................................................................ 50
Carrying out Introductory games ...................................................................................................................... 52
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INTRODUCTION
The National Organization of Peer Educators (NOPE) is a Kenyan organization established in

2000 within the IMPACT project of Family Health International. The idea of NOPE was
borrowed from a similar association working with truckers in Tamil Nadu, India. NOPE was
formed to spearhead peer education as a means for behavior change in Kenya using a
standardized peer education curriculum and behavior change communication strategy. NOPE
has its headquarters in Nairobi and field offices in Mombasa, Kakamega and Naivasha. The
organization’s services are not however limited to the four geographical areas and are
available to organizations across Kenya.
The mission of NOPE is “To build capacity of organizations and communities to manage and
sustain peer-centered programs that address health and social needs while ensuring
stakeholders’ and employees’ satisfaction”.
To achieve the stated mission and remain sustainable, NOPE develops and markets a range of
professional services and technical assistance to companies, NGOs and other organizations.
The technical assistance focuses on development and management of comprehensive HIV and
AIDS programs, including peer education. Through these products and services, NOPE
generates funds to support some of its programs and does not exclusively depend on donor
funds.
NOPE has played a leading role in increasing the scope of peer education from isolated,
project-based activities to a more comprehensive program, using innovative approaches.
From 2003 to 2006, NOPE was an implementing partner of the IMPACT project, funded by
USAID through Family Health International. Currently, NOPE is a strategic partner in the AIDS,
Population and Health Integrated Assistance (APHIA II) project funded by USAID and led by
Family Health International and is responsible for youth and workplace programs.
NOPE has three main programs namely the youth program, the workplace program, and
networking forums. Under the Workplace Program, NOPE provides technical assistance to
Companies and organizations to institutionalize HIV and AIDS programs, based on national
HIV&AIDS strategic plan and the standards, principles and guidelines of the International
Labor Organization (ILO) and the Federation of Kenya Employers (FKE). NOPE provides
technical assistance to formal and informal workplaces in mainstreaming HIV&AIDS in their
normal business.
Currently, NOPE’s workplace clients base is over 51 organizations reaching a combined

workforce of over 132,300 employees. NOPE has provided technical support to 40% of the
companies in formulation of HIV&AIDS workplace policies. Furthermore, 860 managers have
been oriented to ensure ownership and continuity of innovative programs. To date the
Workplace program has trained a total 2,906 peer educators. NOPE also runs a youth program that
remains vibrant by utilizing innovative approaches in reaching young people in Kenya,
Tanzania and Southern Sudan. The approaches which are peer-centered lay emphasis on
skills transfer in communication, abstinence and life skills that include creative and critical
thinking and goal setting. NOPE’s youth program has trained over 3000 peer educators and
has a database of 30 client organizations.
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Value-based experiential learning principles guide the delivery of training of volunteers.

Theatre and peer communication activities are undertaken in the community by over 3000
trained peer educators. The reach by the peer educators is estimated at over 100,000. To
support this, a strong monitoring and evaluation system has been established for quality
assurances in the course of achieving goals.
Sustainability is considered as a crucial element in the program and towards this, youth
serving organizations/ institutions are approached to contract NOPE for services. This is done
alongside carrying out tasks that are supported by development partners that include;
PEPFAR, USAID Kenya through Family Health International (FHI) Kenya in the APHIA II
project, USAID Tanzania through FHI Tanzania the United States Centres for Diseases Control
and Prevention (CDC) and Action Aid International Kenya.
NOPE is a technical partner in the UJANA project, a 5-year (2006-2010) program for youth in
Tanzania in 5 regions that includes Zanzibar. NOPE’s mandate is strengthening the capacity of
youth-serving organizations and to will promote the utilization of standardized tools adopted
from the Youth Peer Education Toolkit.
To strengthen networking among youth peer educators, NOPE is spearheading the Youth Peer
Education Network (Y-PEER) in Kenya and the region. NOPE has already facilitated revision of
the Y-PEER curriculum for use in Africa. Y-PEER is a global network that was started by
UNFPA in Eastern Europe and Central Asia to link programs and improves tools for youth
peer education programming. NOPE is the network’s host in Kenya and will continue to play a
technical role in its expansion to other African states as it has done in Tanzania. The program
has coordinated the adoption of a trainer’s manual for use in Kenya and Tanzania and
standards in peer education in the latter.
In order to facilitate experience sharing and promote the replication of best practices, NOPE organizes
forums such as exchange visits, peer educators’ days and conferences for different stakeholders.
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UNDERSTANDING THE PEER CONCEPT
Who are Peers?
In the context of this guide, peers are people who belong to the same social group and
similarities in various aspects that could include age, type of career, job cadres, religion, social
interests, economic grouping, social status, age sets, or other similarities.
What is Peer Education?
Peer Education is the process whereby well trained and self-motivated community members
undertake informal or organized educational activities with their peers over an extended
period of time to develop their knowledge, attitudes, beliefs and skills and enable them to
make informed decisions about their health and social lives (UNAIDS, USAID, UNFPA Y-PEER)
Peer education can be used with many populations and age groups for various goals. Recent
use has been in HIV prevention, control of AIDS and Reproductive Health programs around
the world.
Table: Types of Peer Led Approaches:
Peer Information Peer Education Peer Counseling

Awareness Awareness Information
Objectives Information Information Attitude Change
Attitude Change Attitude Change Prevention skills
Behavior Change Problem-solving skills
Coping Skills
Self-esteem
Psychosocial Support
Coverage High Medium Low
Intensity Low Medium/High High
Confidentiality None Important Essential
Focus Community Large Small Groups Individual
Groups
Training Brief Structured Intense and Long
Required Workshops
Refresher Courses
Example of IEC material Continuous group Counseling peers living

Activities distribution activities with fears or health
World Health Continuous referral conditions
Days activities Referring peers for medical
Material distribution assistance
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RATIONALE FOR PEER EDUCATION
Advantages Challenges
 Employees young people and  If peer educators outgrow their

community members take on roles, new people have to be
programmatic responsibilities trained
 Educators can use same languages  They can pose larger
and slang terms management problems and
require skilled supervisors
 Peer Educators gain skills that are
important for their continued  Require proper monitoring and
personal development evaluation skills and budgets to
evaluate the impact of peer
 It can supplement other
education
educational interventions like
work of teachers, social workers  If Peer Educators are not well
and development workers trained it can result in
misinformation and
 It provides a link to other
unprofessional advice
community services
 It is relatively inexpensive
compared to other interventions
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THEORETICAL BASE FOR PEER EDUACTION
The field of Community Health Psychology and public health provide various behavioral
theories that explain this process
Theory Application in Peer Education

Theory of Reasoned Action: People’s attitudes are highly influenced by their
peers and their perceptions of what the peers do
This theory states that a person’s behavior and think. People might also be influenced by the
is determined by: expectations of the peer educators
A person’s subjective beliefs, that is, his or
her own attitudes towards his behavior and
the consequences of the behavior
A person’s normative beliefs, that is, how a

person’s view is shaped by norms and
standards of his/her society and by the
norms and standards of his/her society and
whether people they hold as important
approve of the behavior
Social Learning Theory (By Albert It implies that inclusion of experiential learning
Bandura) activities are essential, and peer educators can be
influential teachers and role models.
People learn:
Through direct experience
Indirectly, by observing and modelling
behaviour of other whom the person
identifies
Through training that leads to confidence in
being able to carry out behaviour
Diffusion of Innovation Theory: Peer Educators can be opinion leaders within a
States that social influence plays an peer group. The role of opinion leaders as
important role in behaviour change. The educators is important especially where the
role of opinion leaders in a community, target audience is not reached exclusively
acting as agents of behaviour change, is key through formally planned activities but through
element in this theory. Their influence on everyday social contacts
the group norms or customs is
predominantly seen as a result of person-to-
person exchanges and discussions
Theory of Participatory Education: The process of taking peer educators from the
affected community and involving them in
The theory states that empowerment and determining a course of action is key to the
full participation of the people affected by a success of a Peer Education project
given problem is key to behaviour change
Health Belief Model (By Godfrey The theory is used to predict behaviour mainly
Hochbaum, Stephen Kegels, and Irwin through perceived susceptibility, perceived
Rosentock): barriers, and perceived benefits.
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The model suggests that if a person has a The person’s opinion of the tangible and
desire to avoid illness or to get well (value) psychological costs on the advised action can be
and a belief that a specific health action reduced by a peer educator through reassurance,
would prevent illness (expectancy), then correction of misinformation, motivation, and
they would a positive behavioral action with assistance.
regards to that behavior.
Social Ecological Model for Health
Promotion:
While peer education is an important
States that behaviour is determined by: intervention to affect interpersonal and intra-
 Characteristics of the individual such personal changes, to succeed it is important to
as knowledge, attitudes and coordinate it with other efforts defined to
behaviour, self-concept, and skills influence institutions, communities and public
 Formal and social networks and policies
social support systems including the
family, work group and friendships
 Social institutions with
organizational characteristics and
rules (formal and informal) of
operation
 Community factors – relationships
among organizations, institutions,
and informal networks within
defined boundaries.
 Public Policy – from local, national
and international policies
Information, Behavioural, Skills and
Resources ( IMBR) Model:
Focus largely on Information (the what), the It means that peer education cannot be complete
motivation (the why), the behavioural skills if it does not have all four components of the
(the how) and the resources (the where) IMBR model for reduction of risk behaviours and
that can be used to target at-risk promoting healthier lifestyles. It is important fro
behaviours. peer educators to provide peers with
information about where to access services and
resources beyond peer education sessions
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Experiential learning:
Tell me… I forget, Show me… I remember…. Involve me…I understand.

Ancient Proverb
Involving participants in active learning that incorporates their experience during peer
education training workshop is essential. Such experiential learning gives them opportunity
to develop their skills and receive immediate feedback. It also enables them to participate in
training exercises and techniques first hand, before they engage their peers in similar
exercises.
Diagram: The cycle of experiential learning:
1. Participation
(The trainer introduces the activity
and explains how to do it)
Participants participate in:

 Brainstorming
 Role-plays
 Experience Sharing
 Story Telling
 Group Discussions
 Participatory games
4. Application 2. Reflection
Next Steps (The trainer gives Thoughts/feelings (trainer guides
suggestions) discussions)
Participants Discuss: Participants (trainees) participate in:

 How the knowledge/skills can  Answering questions
be useful in their lives  Sharing reactions to the
 How to overcome difficulties activity
in using the knowledge/skills  Identifying key results
 Plan how to apply the skills
3. Generalization
Lessons Learned (The trainer
gives information, draws out
similarities and differences,
summarizes)
Trainees participate in:

 Presenting their results and
drawing general Page 9
conclusions
HARVESTING, SORTING AND ANALYSING QUESTIONS FROM PEERS AND

PEER EDUCATORS
The role of questions in the dialogue process:
Questions build community ownership of information: This is especially when the

community members receive information when they ask/demand for it. The person asking
the question determines what type of information to be shared during the session or a
subsequent one.
Questions raise the level of debate and interaction: Debates on controversial issues in the
community are enhanced best when question rise about them during Peer Education sessions.
Promote a culture of questioning selves and others: Questions develop community

interaction and dialogue by promoting a culture of questioning relationships, values, myths,
practices, assumptions, etc.
Create a safe environment of r Peer Education sessions: Questions help by creating a safe
and conducive distance for the peer educator to handle and probe sensitive community issues
How are questions harvested?
It is the role of Peer educators and the program persons to harvest questions to serve the
programs purposes mentioned above. Harvesting of questions is best done:
 During Participatory sessions- when the question is still hot: Questions are best
harvested immediately they strike the mind of the peer/participant. The peer educator
should be observant of demeanors of peers during sessions to be able to identify the peers
that want to ask questions or give opportunities.
 Immediately after the sessions: This is common especially with personal questions or
questions from participants who do not want to be session as being behind others in
grasping issues from the session.
 Using the appropriate and quick methods: A peer educator can use all appropriate
methods to gather question from peers. Giving peers time to ask questions during session
often proves more effective as the peer educator would gauge whether it is a common
question/concern in the group based on their reaction to it when it is posed. Other modes
include the use of Question cards but it is not often participatory. Questions asked through
this mode are often handled on one-one basis unless the person asking it does not state
his/her name.
 Categorizing harvested questions: The coordinators and zone leaders should be able to
assist the peer educators in sorting out and analyzing the questions harvested during the
peer education sessions. The mouth is the gateway from and to the heart and mind.
Questions from participants are often based on the information they would want to get.
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This would therefore indicate the type of actions they want to take after getting such
information or after their concerns have been clarified.
The following are the categories of questions that often emerge during Peer Education
sessions:
Category of Significance Example

Question
Questions that seek  What is the name of the germ that
Factual information that can be causes TB?
Questions verified and proved. The  Where in the body are antibodies
answers are based on produced?
knowledge, facts and  What is the size of HIV virus?
statistics
Questions that arise  Does a person rape because of the
Opinion from and reflect way a woman dresses?
questions individual’s belief,  Do you believe that marrying
attitudes or views. more than one wife is wrong?
Also in this category are  Should the government provide
questions that seek ART to everyone who is HIV
opinions of the Peer positive?
Educators or another  Should widow cleansing be
persons declared illegal?
Also here are questions  Why are only poor Africans dying
based on misinformation of AIDS?
and assumptions  Why is it that even catholic priest
who are celibate are dying of
AIDS?
Also here are questions  I think I am infected, what should I
that seek guidance do?
Rhetorical At times referred to as  Where did HIV originate?
Questions non-questions. They do  Why does God allow children to be
not reflect a serious infected with HIV?
information need or gap.  When will men stop being what
They may be used to they are?
pose a challenge to the
peer educator or group
of peers. Some of the
sound like questions but
they are not seeking any
specific answer
While factual questions are inspired by intellectual curiosity, opinion/personal questions
arise out of predicaments or issues of indecision.
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The quality of questions:
Questions play a big role in learning and in behavior change. The quality of inquiry reflects
the following:
 Low mastery, many questions: People ask fewer questions about what they have mastery
on and more questions on issues they feel to have low mastery on.
 New knowledge creates new questions: When an old topic requires a new aspect, new
questions arise. Good discussions create new knowledge: Good discussion adds new aspects
and details to old issues. This creates new and deeper questions. A person who assumed that
HIV is transmitted efficiently through sexual intercourse will have a lot of question when he
learns that this is the least efficient mode of transmission.
 New question die quickly: Questions that arise as a result of participatory discussions have a
short life. As the discussion moves ahead, the questions that the individuals had disappear
within one or two minutes
 Harvest when the discussion is hot: Good facilitators are aware that questions come
quickly. They hence capture the questions before they disappear. This is similar to harvesting
crops that have been produced by well-cultivated discussion. The facilitator should be able to
harvest such questions from the participants before they move to the next topic. The Peer
educators should be assisted in identifying and capturing the questions in order to move to
deeper discussions
Relating Harvested questions to the Behaviour Change Continuum
Questions can tell the attitude, feelings and probable action an individual is likely to take or
want to adopt. This can be demonstrated in the tale below:
Possible feeling/attitude Type of question

I am not at risk Rhetorical/non-question
I have had sex with many partners Factual/technical questions
I have an STI Factual questions
I am a caregiver of someone with Questions seeking Opinion
HIV
I would like to go for VCT Questions seeking Personal opinion
I am HIV positive Questions seeking advice on what to
do
I am living with HIV Questions seeking opinions on what
to do
I have AIDS Questions that seem to negotiate
Conclusion:
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The type of question harvested can tell whether the individual asking the question is t any of
the stages in the behaviour change continuum. The peer educator should hence be tactful
enough to know how to handle the question appropriately.
Developing sessions from Questions from Peers:
Type of question Action by Peer Educator

Factual/ technical  Ask other participants to respond to it
questions: Seeking  If the participants have a wrong response then the
factual information Peer Educator could share a correct answer in the
form of a question
 If the response is inappropriate, re-do the session
that is causing the confusing
Seeks opinion f others  Refer the question back to the audience and ask
others to share their opinions
 If appropriate, use a process tool to process the
values, beliefs, fears, and options for alternative
responses form the audience (e.g. Picture code, role-
play, timeline, experience sharing, or figurehead
tools)
 Discuss facts related to the question
Seems personal,  Explore facts only if appropriate
emotional, or arising  Seek an opportunity for one-one talk with the peer to
from some personal explore the source of the question
circumstance  Refer the peer for the relevant services e.g. HIV
testing, counseling, etc.
 Bring up the issue for exploration and use a process
tool to process the values, beliefs, fears, and options
for alternative responses form the audience (e.g.
Picture code, role-play, timeline, experience sharing,
or figurehead tools)
 If it appears that the person is assessing or trying out
a desirable new behaviour, provide support
(midwifing), plan a session for magnifying the
behaviour change with the group, or suggest a forum
for sharing best practices
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Behavior Change Communication (B.C.C) Strategy
Behavior Change Communication
BCC has its roots in Behavior Change Theories evolved over the last few decades which form
valuable foundations for developing comprehensive communication strategies and programs.
Behavior Change Communication (BCC) is the strategic use of communication to promote
positive health outcomes, based on proven theories and models of behavior change. It is a
multi-level tool for promoting and sustaining risk-reducing behavior change in individuals
and communities by distributing tailored health messages in a variety of communication
channels. It also the process by which the community is engaged in dialogue to honestly
reflect their behaviors, attitudes, beliefs and practices with the aim of helping them see how
they will benefit in different areas in life from the change.
The Strategic Role of Behavior Change Communication
Effective B.C.C has many different, but related roles to play in HIV & AIDS programming. It
should:
 Increase Knowledge – It ensures that people have the basic facts in a language, visual
medium or other media that they can understand and relate to so that they are motivated to
change their behaviors in positive ways.
 Stimulate Community Dialogue – It can stimulate community and national discussions on the
underlying factors that contribute to the epidemic, such as risk behaviors, risk settings and the
environments that create these conditions. It should create a demand for information and
services, and spur action for reducing risk, vulnerability and stigma.
 Promote Advocacy – Integrated advocacy ensures that policy makers and opinion leaders
approach the epidemic seriously. Advocacy takes place at all levels, from the national down to
the local community level.
 Reduce Stigma and Discrimination by promoting communication on HIV/AIDS and attempt
to influence social responses to them.
 Promote Essential Attitudinal Change – It can lead to appropriate attitudinal changes such
as perceived personal risk of HIV infection, belief in the right to and responsibility for safe
practices, and greater open mindedness concerning gender roles.
 Promote Services for Prevention Care and Support that address STIs, orphans and vulnerable
children (OVC), voluntary counseling and testing (VCT) for HIV, mother-to-child transmission
(MTCT), support groups for people living with HIV/AIDS (PLHA), clinical care for opportunistic
infections, and social and economic support. It can also improve the quality of these services
by supporting providers' counseling skills and clinical abilities. It creates demand for
Information and Services.
 Improve Skills – BCC programs focus on the achievement or reinforcement of new skills and
behaviors such as abstinence, condom use and negotiating for safe sex.
 Spur Action for Reducing Risk, Vulnerability and Stigma – It can motivate audiences to
change their behaviors in positive ways.
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The Goals of Behavior Change Communication
BCC strategies in HIV/AIDS aim to create a demand for information and services relevant to
preventing HIV transmission, and to facilitate and promote access to care and support services. Some
specific BCC objectives include:
 Increasing the adoption and continued use of safer sex practices;

 Promoting visits to clinics treating STIs and opportunistic infections, including tuberculosis;
 Increasing the demand for VCT, for MTCT prevention services, and for OVC care and support;
 Increasing the adoption and continued use of safer drug-injecting practices;
 Stimulating dialogue and discussion on risk, risk behavior, risk settings and local solutions;
and
 Reducing stigma and discrimination for those living with HIV/AIDS.
Summary of Behavior Change Theories

1. Health Belief Model (HBM): HBM focuses on how individuals perceive and barriers for
performing behaviour, their perception of their susceptibility to a disease or condition, and
their perception of the severity of the disease or condition (Janz et al.2002). Self-efficacy –
an individual’s belief that he or she can perform certain behavior in a specific setting – is
factored into the model. All of these constructs influence whether an individual will or will
not perform a particular behavior. The most influential construct in the HBM is perceived
barriers (Janz and Becker 1984).
2. Social Cognitive Theory (SCT): SCT synthesizes personal influence, behavior and
environmental factors to explain how behaviors change. Taking this perspective into
account, an SBC strategy is incorporate into a comprehensive HIV/AIDS preventions care,
support and treatment framework. SCT emphasizes that behavior change will not occur
unless other systems are present to support people’s decision. To address one aspect of the
cognitive construct of behavior change. The intervention includes materials such as
brochures and posters to give people the information they need to make decision.
3. Diffusion of Innovation Model: This model is based on how new ideas or behaviors are
promoted by influential members of specific groups, and how ideas or behaviors are
diffused to others within the groups. Many factors affect the likelihood that group
members will adopt these ideas and behaviors. Such as their complexity, the ease with
which they can be communicated, the risk involved in adopting or changing the
ideas/behaviors, and behavior can be observed, (Oldenburg and Percel 2002).
4. The Behavior Change Continuum: The world Bank endorses the ‘’ stages of change’’
continuum, adapted by the trans-theoretical model (see below) The behavior change
continuum consists of these steps, unaware, aware, concerned and knowledgeable,
motivated to change, trial of new behavior, and maintenance of new behavior. (The World
Bank 1996). Different communication strategies can be used, depending on the group’s or
individual’s position along the continuum. If someone is in the ‘’aware, concerned and
knowledgeable’’ stage, the communication program can address the benefits and barriers
of a particular behavior.
5. Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TRB): The
TRA links individual beliefs, attitudes, subjective norms, and intentions to practice
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behavior. It is based on the premise that people are rational and have some control of
their choices. (Montano and Kasprzyk 2002).
SETTING PROGRAM, & BEHAVIOUR CHANGE COMMUNICATION (B,C,C)

GOALS
What is B.C.C?
An interactive process with communities
• Integrated into the overall HIV and AIDS program
• To develop tailored messages and approaches using a variety of communication
channels
• To develop positive behaviors to promote and sustain behavior change
What is the Role of B.C.C in HIV & AIDS Programs?

• Increase knowledge
• Stimulate community dialogue
• Promote essential attitude change
• Advocate for policy changes
• Create a demand for information and services
• Reduce stigma and discrimination
• Promote services for prevention and care
Goals of B.C.C
• Promote Safer sex practices (abstinence, delayed debut, less partners, condom use)
• Promote Improved health care seeking behavior for STIs, TB
• Promote VCT and other services (PMTCT)
• Create a demand for HIV and AIDS information
• Harm reduction of IDU (safer injecting)
• Stimulate community discussion on risk
• Reduce stigma and discrimination
• Promote Blood safety -- better practices, donor recruitment
• Promote positive Health worker attitudes and practices
B.C.C Guiding Principles:

• Integrated in a comprehensive HIV and AIDS program
• Based on systematic (formative) assessment
• Developed with active participation of the stakeholders & the community
• Using a variety of communication channels
• M & E planned at the beginning
• Involvement of PLWA
• Positive and action oriented
• With pre-testing of messages and materials
Why Behavior Change is a slow process:

• Habits are acquired over time hence leaving also takes time (traditions die hard)
• Attitudes develop due to experience and style of doing things over time
• Dependence on rules, conventions that give no room for freedom of choice.
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• Fear of the unknown: How ideas are presumed risky until …

• Economic costs: The new undertaking has a price.
• Security: belief that only what is known is safe.
B.C.C in Support and Care:

We need BCC in care and support due to:
• Lack of depth of Knowledge about HIV and AIDS
• Lack of knowledge on OIs
• To promote Care seeking behavior
• Enhance the Quality of service provision
• ART and PMTCT are new hence awareness about them is still low
• Most PLHAs on ART are not informed about possible side effects and what to do
about them
How to target behavior with B.C.C programs
Those seeking care

• Health Care Seeking Behavior
• Drug adherence
Families and Communities
• Empowered with knowledge
• Reducing stigma and discrimination
Those providing care
• Empathy and understanding
• Clarity of information
Addressing Stigma through B.C.C
Prevention
 Stigma inhibits self risk assessment
Quality of Care
• Stigma perpetuates poor quality of care
• Stigma inhibits health care seeking behavior
Policy
• Stigma helps to perpetuate discriminatory laws and practices
• All BCC activities should address issue of stigma
What B.C.C cannot do :
BCC cannot do the following hence cannot be set as BCC objectives or Goals:
• compensate for poor planning, inadequate support
• overcome poor management
• substitute for lack of training
• transform deep-seated cultural norms and well established behaviours in a short
period of time
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Essential steps to develop a Behavior Change Communication Strategy
BCC employs a systematic process beginning with formative research and behavior analysis,
followed by communication planning, implementation, and monitoring and evaluation.
Audiences are carefully segmented, messages and materials are pre-tested, and both mass
media and interpersonal channels are used to achieve defined behavioral objectives.
The following steps incorporate careful analysis, feedback and redesign throughout the entire process.
Step 1: Identify the problem based on the overall program goals.

Step 2: Segment target populations.
Step 3: Engage in formative research.
Step 4: Identify behavior change goals.
Step 5: Seek consensus from stakeholders.
Step 6: Design communication plan, including objectives, overall theme, specific messages
and outlets for dissemination.
Step 7: Pre-test and revise.
Step 8: Target communication to specific groups.
Step 9: Implement the plan.
Step 10: Monitor and evaluate it.
Step 11: Seek feedback and make appropriate revisions.
B.C.C Impact Indicators
The steps to Behavior Change Communication (BCC) identifies intermediate program effects
and specifies indicators to measure as the process unfolds towards its final outcome,
sustained behavior change. The measurement of intermediate steps or sub indicators
provides opportunities for early assessment in time for corrective action by program
managers. The basic indicators of individual behavior change through each step include:
Knowledge – Recalls specific messages, understands what messages means and can name
products, methods, or other practices and/or sources of services/supplies
Approval – Responds favorably to messages, discusses messages or issues with members of

personal networks (family, friends), thinks family, friends, and community approve of
practice and approves practice.
Intention – Recognizes that specified health practices can meet a personal need, intends to
consult a provider and to practice at some time
Practice – Goes to a provider of information/supplies/services, chooses a method or practice

and begins use and continues use.
Advocacy – Experiences and acknowledges the benefits of practice, advocates the practice to
others and supports programs in the community.
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Towards Strategic Behavioral Communication, more than just B.C.C
Introduction
Africa is faced with increasing cases of HIV/AIDS with corresponding needs for stigma reduction, care,
and treatment and psychosocial support initiatives. The utmost concern is the slow attitudinal change
among the community on sexuality and cultural practices that contribute to the spread of HIV.
Behavior Change Communication, usually referred to as just BCC, came in handy as the best approach
to counter the problems and subsequently slow the spread. To encourage behavior change,
programmers designed many communication strategies.
With the strategies came BCC messages and BCC materials development. These two are hailed in some
quarters as having reduced HIV prevalence rates in some countries. However there as the HIV and
AIDS programming becomes more detailed it is emerging that BCC dos not fully address other crucial
areas. Abstinence for example is not about changing behavior but more about maintaining a behavior
and so is adherence to prescribed drugs.
There has been therefore need to move beyond BCC into more strategic communication in what has
been branded as Strategic Behavioral Communication, SBC. Many programmers associate BCC
exclusively with prevention. As antiretroviral therapies became increasingly available, new
communication needs surfaced within a wider range of program components, including care, support,
treatment and impact mitigation.
For example, we have learned that the communication needs of population affected by HIV and AIDS
are complex and continually evolving. While some people may have just sero-converted, other may be
experiencing an increased viral load, a drop in CD4 cell count and the need for palliative care, while
still others are recovering and experiencing a period of wellness.
SBC can support prevention intervention, including counseling and testing, home-based and palliative
care. SBC can also support such mitigation interventions as programs for orphans and other
vulnerable children, as well as such treatment interventions as antiretroviral therapy, treatment for
opportunistic infections and tuberculosis, and programs to prevent mother-to-child HIV transmission.
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What is S.B.C?
Strategic behavioral communication (SBC) is an interactive process that promotes positive behavior
change on the individual, community and societal level while encouraging maintenance of positive
behaviors. It represents a new stage in the evolution of behavior change communication (BCC).
SBC breaks new ground by engaging individuals and communities in developing tailored
communication strategies. SBC, just like its predecessor BCC, utilizes a mix of communication
intervention and channels. SBC supports the entire continuum of HIV/AIDS programs, from
prevention to care, support, treatment and mitigation.
SBC often uses advocacy, community mobilization, social mobilization and social marketing
approaches to reach its goals, creating a synergy with these intervention to support behavioral and
health objectives.
SBC’s Guiding Principles

SBC is planned and implemented in the context of a comprehensive range of HIV/AIDS interventions
and programs. Given these comprehensive goals SBC must:
 Be integrated with all relevant program goals and intervention, and linked to services and
commodities from the start of program design.
 Be applied across entire program in a consistent, complementary fashion, so its messages,

channels and activities reinforce each other and improve chances of success.
 Use a variety of linked communication channels, which is more effective than replying on just
one.
 Be designed and implemented in a participatory fashion to involve all relevant beneficiary

populations, local stakeholders and, especially, people living with HIV/AIDS (PLHA).
 Be designed at the program site and tailored to the needs of beneficiaries, stakeholders and
local populations.
 Be based on evidence by assessing the perceptions, levels of knowledge, attitudes, beliefs,

barriers and motivating factors of beneficiary populations through data collection of data and
other sources, and from documentation of lessons learned about similar interventions.
 Be based on results that can be observed, documented and presented as concrete outputs and
outcomes, with the aid of monitoring and evaluation (M&E) systems.
 Be built on quality assurance/quality improvement, meeting established quality standards

based on international best practices and accommodating ongoing and systematic quality
improvement.
 Be sustainable by contributing to the development of system that can be maintained over time.
 Be responsive change through feedback, even after implementation has begun
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 Help create partnership, collaborating with other local and/or international partners to ensure
that program goals are reached.
 Be gender sensitive.
Redefining Behavior Change

Some experts believe that the term “behavior change” does not accurately describe behaviors as
abstinence or adherence to treatment regimes, because these examples represents the maintenance or
slight modification of existing behaviors rather than full-blown behavior change. By focusing on
behavioral objectives change, SBC broadens the types of behavioral outcomes it contributes to.
In some countries “ behavior change” has developed a negative connotation association with imposed
or top-down approaches. SBC reaffirms that effective HIV/AIDS programs must be participatory,
locally developed, locally implemented in accordance with community customs and traditions, and
sustainable.
In addition, SBC emphasizes the importance of collaboration between SBC interventions and allied
efforts, including advocacy, community mobilization, social mobilization and social marketing, to
create comprehensive approaches to achieving behavioral outcomes.
What Can SBC Do For HIV & AIDS Programs?

Well planned and executed SBC interventions can help achieve program goals by promoting the
knowledge, attitudes, skills and behaviors necessary to adopt or maintain healthy behaviors. SBC
interventions can also support behavioral outcomes at the individual level by promoting changes in
social norms and creating an environment that enables positive behaviors.
Prevention
S.B.C Can:
 Increase the perceived benefit among defined beneficiary population to adopt HIV prevention
behaviors, including abstinence, being faithful and using condoms.
 Promote prevention among PLHA, their partners and their families in the care setting.
 Promote changes in social norms to allow for more open discussion of sexuality between
parents and children to help delay the onset of sexual activity.
Care and Treatment

S.B.C can:
 Help reduce stigma and discrimination among health care providers to improve care and
treatment services for PLHA.
 Create demand for counseling/testing (CT), OI/TB, STI and other clinical services among
specific population.
 Support training of health care providers and of outreach and home-based care workers to
provide better information and counseling on side effects, opportunistic infections (OI),
nutrition and exercise during home visits to support PHLA and to assist clients taking
antiretroviral therapy (ART) and OI medication.
 Promote informed decision making for pregnant women, especially those with HIV for AIDS, so
they can make the best choices for their health and the health of their infants.
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 Improve thee skills and self-efficacy of PLHA to adhere to ART and seek medical help as
needed.
Mitigation
S.B.C can:
 Stimulate community dialogue to develop appropriate responses to issues affecting orphans
and other vulnerable children.
 Partner with mass media to help improve coverage of HIV-related issues, set an appropriate
community – or society-level agenda, and help support an enabling environment for HIV/AIDS
program goals.
Policy
SBC can promote essential attitude change among policymakers for increased budget allocations for
HIV & AIDS programs.
Developing S.B.C Interventions: A 12-Step Approach

FHI has developed a step-by-step approach to help programs develop comprehensive SBC strategies.
Because programs often unfold in unpredictable ways, the sequence of the steps below may not
always be appropriate. The best time for each step depends upon local circumstances, as well as the
planning and activities related to other program components.
Step 1. Establish program goals and conduct situational assessment: Although program goals are
typically established before the SBC strategy design process, practitioners need to be aware of these
goals and use them to help develop SBC strategies. In particular, data from situational assessment can
guide the development of behavioral and communication objectives. These usually involve analysis of
the demographic, epidemiological, economic, and political and media environments.
Step 2, Involve stakeholders and other key people: Stakeholders and other key people (decision
makers, gatekeepers, “influentials” and opinion leaders; see Glossary) have an interest in, might
benefit from, may affect or may be affected by the outcome of an HIV/AIDS program. Stakeholder
involvement throughout all stages of program design and implementation facilities community
ownership and gives the program its best changes of success.
Step 3. Identify beneficiary population and ensure a plan for baseline: The most effective SBC
interventions are designed for well-defined beneficiary population. These are selected based on
epidemiological information, population surveys, donor mandates and more. Building programs
around specific beneficiary population allows SBC to focus on the communication needs of these
defined populations for maximum behavioral outcomes.
Step 4. Conduct formative assessment (audience analysis): SBC strategies are based on in-depth
information about beneficiary population usually obtained through formative assessments or
audience analysis. Such assessments provide an “insider” understanding of beneficiary population and
describe the contexts in which those populations exist from their own perspectives.
Step 5. Segment beneficiary population: Segmenting helps SBC practitioners design strategies that
address the needs of specific groups of beneficiary population (people with similar characteristic).
Formative assessment results can help programmers segment beneficiary population, clarify their
specific needs, and formulate strategies and programs to best address those needs.
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Step 6. Confirm or refine behavioral and communication objectives: Formative assessment allow
SBC practitioners and collaborating research and evaluation experts to confirm or refine behavioral
and communication objectives. Behavioral objective refers to specific behavior to be adopted and/or
maintained. Communication objectives refer to changes in levels of awareness, knowledge, concern,
risk perception, motivation or intention to change or continue maintaining specific behaviors. All
objectives should be “SMART” (specific, measurable, appropriate, realistic and time-relationship
between behavioral and communication objectives.
Step 7. Design SBC strategy and monitoring and evaluation plan: An SBC strategy includes clearly
segmented beneficiary population and their profiles, behavioral and communication objectives,
barriers and motivating factors to change, key benefit statements, themes and messages, and an
appropriate combination of activities and channels as well as links to services and commodities.
Step 8. Develop SBC activities, materials and monitoring tools: Developing draft materials activity
plans, monitoring tools and training curricula, as well as training trainers and peer educators, requires
coordination and the expertise of various specialists. At this stage (as throughout the entire program),
SBC practitioners must maintain solid relationships with program managers to ensure services and
commodities can meet the increased demand that SBC generates.
Step 9. Pre-test: Pre-testing uses such qualitative methods as focus group discussions and interviews
to gauge the reactions, levels of acceptance and understanding of sample messages and draft materials
by beneficiary population before messages are finalized and materials are produced. Pre-testing is
essential to help determine whether messages materials, training curricula or monitoring tools will be
effective.
Step 10. Implement and Monitor: Implementation is the process of putting an SBC strategy into
action. Monitoring tracks and measures process, reach and quality. Implementation plans should state
program goals, behavioral and communication objectives, and indicators, and relate all monitored data
to them.
Step 11 Evaluate: Evaluation helps determine if interventions have accomplished their pre-
determined goals and objectives. Because evaluation measures “outcomes” and impact,” it relies on
quantitative and qualitative data. These data can be obtained through follow-up survey to baseline
studies, exit survey at clinic and hospitals, qualitative assessments and other studies. Well-defined
indicators based on SMART behavioral and communication objectives can help link program results to
SBC interventions.
Step 12: Analyze feedback and re-design: Feed-back is the process of gathering and assessing
monitoring and evaluation data to communicate the success and challenges of SBC interventions to
practitioners and key stakeholders. Feedback provides the opportunity to revise SBC interventions to
better beneficiary population. Ongoing collection of qualitative data, analyzed alongside process
monitoring and evaluation results, can yield excellent feedback.
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Linking Behavioral and Communication Objectives

Illustrative behavioral objectives Illustrative communication objectives
Increase condom use during commercial  Increase motivation to use condoms among
sex among truckers by 30% in country X in truckers by 25% within six months
one-year period
Delay the onset of sexual activity among in-  Increase the perception of abstinence as a positive
school youth ages 11 to 16 by one year in a lifestyle among-in-school youth ages 11 to 16 by
specific location over a two year period 40% within two years.
 Increase by 25% girls ages 11 to 16 who acquire

assertiveness and refusal skills in support of
abstinence
Increase ART adherence by 20% among  Increase knowledge of ARV facts, availability and
PLHA ages 19 to 35 in a specific location side effects management among PLHA ages 19 t o
over a two-year period 35 by 40% within one year.
 Increase perception of self-efficacy to remain o

treatment among PHLA ages 19 to 35by 25%
within six months
Increase the use of HIV counseling and  Increase motivation tolearn one’s HIV status
testing services by out-of-school youth ages among out-of-school youth 18 to 22 by
18-22 by 25% community “x” in one year 25%within two years.*
period.
 Increase perceived benefit of knowing one’s HIV
status among out-of-school youth age 18 to 22 by
25% within two years
 Reduce stigma associated with use of CT services:

reduce by 25% within one year the number of
out-of-school youth ages 19 to 35 who believe
that only people who practice risky behaviour
use of HIV testing services.*
* Compared to baseline
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Linking Strategic Communication Components to Program Goals

Program goal  Reduce AIDS morbidity and mortality
Current behaviors  Low uptake of ART services; high dropout rate among those on ART
and low adherence to ART
Desired behaviors  Patients accessing ART services; ART patients adhering to treatment
regimes
Behavioral objective  Increased number of patients accessing ART services
 Increased number of patients starting ART
 Increased number of ART patients adhering to treatment regimens
Communication  Increased awareness of existence of ART services
objective  Increased motivation to access ART services
 Increased knowledge of the benefits of ART
 Increased concern about adherence to ART
Barriers to change  Lack of awareness about treatment efficacy and availability
 Fear of side effects and lack of self-efficacy in overcoming them
 Past experience being stigmatized by health providers
 Lack of peer support
 Perceived low-quality client-provider interaction at ART services
 Complexity of treatment regimens
 Failure to take medications when client feels better
Motivating factors  Desire to watch children grow to maturity
 Desire to provide security for children
 Self-efficacy (belief that one is capable of taking care of one’s self)
Key benefit  “If I stay with ART as prescribed y my doctor, I can increase my
statement chances of leading a normal life and improve the possibilities of being
available and capable in the future to support my children and watch
them grow up”
Sample SBC  Interpersonal communication (client-provider interaction, health talks
activities at clinics/hospitals, peer education) to educate patients on basis facts
of ART, side effects and their management
 Training for providers on: (1) how to work with patients to maximize
adherence, (2) designing adherence strategies with patients and (3)
educing stigma and discrimination toward PLHA/patients
 Advocacy to policymakers to make ART available and affordable
 Promotion of ART services to beneficiary population through
traditional and small media (see Glossary)
 Outreach sessions with family member to reduce stigma and
discrimination and increase support for patient ART adherence
 Mass media campaigns to reduce of stigma and discrimination
 Education and skills building for PLHA through outreach and support
groups to increase self-efficacy.
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Choosing the Right Combination of Channels

The optimal way to disseminate messages is through a combination of mutually reinforcing channels:
 Interpersonal channels: counseling, support groups, community meetings, small group

discussions, telephone hotlines, home-base care client providers and clinic staff discussion
with clients, and so. Interpersonal channels have been found to the most effective for
influencing behavioral outcomes, in part because many people are greatly influenced by the
opinions and behaviors of people to whom they feel close.
 Small media: flip charts, brochures, leaflets, job aid, cue card, picture codes, comics, video and
audio tapes, and so on. Small media are effective for supporting interpersonal interactions and
reinforcing mass media.
 Traditional media: local rituals and celebrations, parades carnivals, festivals, music, drama,
puppet shows, and so on. Traditional media are especially effective for influencing attitudes
and social norms, since they are linked to the traditions and customs of a given culture.
 Mass media: broadcast (television and radio) print (newsletters, magazines) outdoors signage,
internet, and so on. Mass media can raise awareness among large numbers of people, because
the mass media carry a certain authority and reliability.
 Special events: Sporting events, school contests, art exhibits, World AIDS Day, etc.
Different channels have been shown to the effective for reaching various beneficiary populations at
different times and for achieving different goals and objective. Identifying the right channels for
specific beneficiary population is key to every formative assessment.
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I.E.C Material Production Guidelines
Section 1: Introduction
Health promotion and health education activities rely on a variety of well designed and
effective IEC materials to help ensure success. From experience, certain fundamentals
pertaining to the development of IEC materials are obvious. Every brochure, poster, videotape
or other piece of IEC material is the product of a decision, supported by research, to deal with
a specific health concern, and to be well received and persuasive among a specific audience.
The success and impact of IEC materials depends largely on the understanding of the target
audience by the IEC material design team. Working with target audience members throughout
the
development of IEC materials, and in developing usage strategies for those materials, helps
ensure
that IEC materials meet the needs of the intended target audience.
This brief paper offers a set of fundamental guidelines for IEC material development teams to
follow in the planning, design (or adaptation) and production of IEC materials. It suggests a
clear, six–step approach, with each step supporting the next, which IEC material design teams
should endevor to follow.
This approach includes:
1. Selecting the most appropriate

IEC material
 Types of IEC materials
 Strengths and limitations of
different IEC materials
 Selecting IEC materials
should be based on knowledge
of the target audience
 Criteria for selecting IEC
materials
 Mixing IEC materials for
more impact
2. Developing a creative brief

 The importance of a creative
brief
 Elements of a creative brief
3. Preparing draft / prototype IEC materials — (or adapting existing materials)

 Guidelines for developing new IEC materials, or selecting / adapting existing IEC
materials
 Qualities of effective IEC materials
4. Pretesting draft / prototype or adapted IEC materials

 Pretest variables — what to look for
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 Steps for carrying out the pretest
5. Assessing pretest results and revising IEC materials

 Changes in materials
 Number of pretests
6. Monitoring the use and impact of IEC materials
Section 2: Selecting the Most Appropriate IEC Material
Health promotion messages are not necessarily expressed with equal ease or effectiveness by
all
IEC materials. Some materials may be more effective in transmitting one type of message
better
than others. Some materials are best suited for transmitting general information, while others
are
better at creating an image or atmosphere. Brochures are useful in getting health information
into the client's home and hands, while mass media such as television and radio are more
suited towardscreating an emotional atmosphere or general awareness of the health issue by
the target audience.
Flipcharts used by a skilled health worker are effective instruments to encourage the
adoption of a
preferred behavior by the target audience. The final decision in selecting IEC materials should
be
based on what the target audience prefers, and has access to.
Types of IEC Materials
For purposes of discussion will focus on two areas or types of IEC materials:
Graphics and audio-visuals — which would include brochures, posters, display boards,
videotapes, slides, flip charts.
Mass media — which would include radio, television, movies, newspapers, and magazines.
Strengths and Limitations of different IEC Materials
Not all IEC materials are created equal. Listed below are some of the strengths and
weaknesses of IEC materials which should be kept mind when selecting IEC materials for
production.
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Graphics and Audio-visual
Strengths Weaknesses
Attracts the attention of the client Training is essential for proper use of
May be distributed / used in a variety of settings materials
Provides basic information on health service by health workers
and benefits If not presented by health worker, does not
Demonstrates steps of behavior (i.e., preparation generally influence behavior change.
and use of medication, methods for preventing Gives credibility to the health worker
mosquito breeding, basic hygiene for food handling
safety, etc.)
Can provide complex information
Is reusable
Supports interpersonal health education sessions
May be produced locally
Provides instant feedback when used by
health workers
Mass Media
Strengths Weaknesses
Reaches many people
Creates a demand for health services May have limited rural distribution
by the target audience For television and radio requires
Reinforces important messages access to
delivered electricity
through interpersonal communication by Requires substantial financial support
health workers Difficult to coordinate with service
Provides status to the health service delivery
program Difficult to tailor messages to specific
Uses influential opinion leaders to audiences
influence target population
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Selecting IEC materials based on knowledge of the target

Audience
When considering the different IEC materials to use, IEC material development teams
should refer to the preferences and characteristics, and knowledge and attitudes of the
target audience. In order to select the most effective IEC material for use in health
promotion activities, the development team needs to be able to answer the following
questions:
 Which material or materials best fit the audience's learning style / preference?
 What are the literacy and educational levels of the target audience?
 Are there any culturally–specific values and beliefs that might impact on the
acceptance of certain material types or designs?
 What are the communities impression's of past, similar health promotion and health
education programs and products?
Members of the target audience can help answer these questions and ensure that a proper
selection of IEC materials is made. In some cases this information may have already been
collected and analyzed by others involved in health promotion / health promotion. These
sources should be investigated and studied. If not, original investigations may be required.
Individuals with experience in carrying out health education / health promotion activities
among the target audience should be sought out and interviewed. Some of the basic
approaches that can be employed in gathering information about target audience
preferences and characteristics, knowledge and attitudes include:
1. Observations
Visit the community for which the IEC materials are intended. Visit social gatherings, health
centers and hospitals, and any other site where IEC materials might be used. Observe how
people react to the materials, and how they interact with each other concerning the
materials.
Record the observations and discuss them with a variety of community members, health
workers, and health education / promotion workers.
2. Informal Conversations
Informal conversations are an unstructured way for the IEC material design team to gain
valuable insight into the nuances of a community. Listen to what people have to say, paying
careful attention to key comments or anecdotes. Look and listen for preferences in
language, symbols, colors, costumes, etc.
3. Surveys
Surveys may include questions on community demographics as well as the knowledge and
attitude by the target audience as to specific health issues (i.e., what is perceived to be a
health problem, its cause and solution). Survey community members and others who may
be able to provide information about the target audience.
4. In depth Interviews
In–depth interviews provide detailed information about the community from its members.
This form of qualitative research is characterized by extensive probing and open–ended
questions, and should be conducted one–on–one between a community member or
Page 30
respondent and a trained interviewer. Also interview health workers, TBA and VHV who
are working or have worked in the community.
5. Focus Groups
Like in–depth interviews, focus groups are characterized by extensive probing and open–
ended questions. Unlike in–depth interviews, though, they rely on group interaction. Focus
groups are the most widely used form of qualitative research. A skilled moderator guides a
group of community members through increasingly focused issues related to the research
topics (i.e. health beliefs and behaviors, barriers to health care access, cultural influences,
or review of health–related IEC materials).
Guidelines for Selecting IEC Materials
The following should be carefully considered when selecting IEC materials for production.
1. Information collected from the target audience investigation will help to indicate the
following:
 Which channels the target audience prefers and has access to — electronic, print,
interpersonal.
 Which channels are most effective for communicating messages to the target
audience.
 Where the target audience is in the stages of behavior adoption (i.e., have accepted
the idea of family planning, but are not sure as to what method to use) and what
channels might be most effective in moving them along.
2. Match the ability of the IEC material to deal with specific message content by applying
the following guidelines:
 Does the IEC material lend itself to the content of the message? For example, radio
can by effective for some content, but less so for messages that require supporting
visuals.
 Is the image or message to be conveyed more visual or more audio based? Or is it
a combination of both? Does it rely primarily on written words?
 Can the chosen material provide the message frequency or reach that is needed?
3. Determine production difficulties and costs as follows:
 Some materials are more costly than others in production. They either require more
professional expertise, more costly production equipment, or more personnel. Radio
production costs are considerably less than television. Even if there is financial
support for the production phase, is there money to continue to air the messages?
 Some channels will take much longer than others to get operational. Production
time constraints may be important.
4. Analyze frequency and reach of the IEC materials as follows:
 Different materials have different audience reach and coverage. While television and
radio can reach thousands of people at the same time, individual focused print
materials can only reach a limited number of individuals at the most. Select the
material, or combination of materials, that best meets program needs.
5. Identify the logistic efforts needed as follows:
 Different materials have different logistical demands. Some materials require much
more effort to distribute or deliver than others. Distributing thousands of posters to
hundreds of health centers is more demanding than sending out audio–cassettes or
video tapes to radio and television stations.
Page 31
Mixing IEC materials for more impact
The message load of a health promotion or health education program is usually greater
than any single IEC material can handle. The success of a health promotion interventions,
therefore, depend to a great extent on an adequate, creative and efficient mix of various IEC
materials. It should not be assumed that one material type is best, nor should the IEC
material development team simply select the IEC material that they happen to prefer or are
familiar with. Planning for the use of different IEC materials in a strategic combination
gives the health promotion intervention the greatest chance of having a positive impact.
Such a combination might include:
 materials for home use — leaflets, calendars, t–shirts
 materials for health center use — flip charts, posters, leaflets, display boards
 materials for community display — posters, banners, stickers
 materials for mass media — radio and television spots, newspaper and magazine
articles
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Section 3: Developing a Creative Brief
After collecting information on the target audience, determining what would be the best
IEC materials to be used, and before beginning the actual design of IEC materials, the IEC
material development team should prepare a "creative brief" for each material to be
prepared. The creative brief serves as a guide, assisting those who will carry out actual
material design and production whether it be an "in–house" effort, or in collaboration with
an outside production firm. The creative brief should define objectives of the IEC material,
identify obstacles to be expected in its use or acceptance, develop draft messages or advice
and support statements, and define the tone of the messages,
and list any other necessary creative considerations such as different language versions or
social conditions.
The Importance of a Creative Brief
The creative brief serves as crucial link between formative research carried out among the
target audience, and developing appropriate and effective IEC materials. It helps translate
target audience background information (formative research results) into actual materials,
and ensures that health promotion interventions reflect and address the concerns and
needs of the target audience. In short, the creative brief serves as a map or guidebook
between the IEC material development team and the "creative people", those who will draft
the scripts, design the posters and prepare display materials.
Elements of a Creative Brief
A creative brief should provide the following information:

 Target Audience. Describe who is intended to be reached with the IEC material?
What are their characteristics — that may affect the way they react to the IEC
material? Do other groups make up a secondary audience?
 Communication Objective(s). What will the IEC material make the target audience
feel, think, believe, do, or not do?
 Obstacles. What beliefs, cultural practices, pressures, and misinformation stand
between the target audience and the objectives of the IEC material?
 Key Message / Advice. Emphasize the benefit of doing, thinking, or feeling what the
IEC material will promote? Why should they follow this advice?
 Support Statement/Reasons Why. Why does the key promise outweigh the
obstacles?
 Tone. What feeling should this communication have? What tone works best with
the target audience? Are they emotional about this issue? Religious? Do they listen
more to authority?
 Creative Considerations. What additional points need to be considered while
designing the IEC material?
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Section 4: Preparing draft / prototype I.E.C material (or adapting existing

materials)
Health promotion programs can quickly generate massive quantities and types of IEC
materials.
Many government and NGO offices continue to increase their holdings of IEC materials.
stockpiles.
If requested, it is usually possible to use another organizations IEC material collection, thus
avoiding the time and expenses involved in designing and producing original materials. If
incorporating text or visuals from copyrighted material, permission must be obtained from
the original, authors or artists.
Most new health promotion initiatives vow to "not reinvent the wheel" and to adapt
existing IEC materials. Adaptation generally requires less time and resources than starting
from the beginning.
Often, a piece of the material contains some useful information but is not written at an
appropriate reading level. Or it may contain suitable visuals or graphics, or a unique
approach to presentation, without the appropriate message. The effort that went into
developing such materials can be enhanced by adapting them to meet the needs of a new
target audience.
Qualities of Effective I.E.C Materials
Effective IEC materials should attempt to:

1. Create a distinct look and personality — Effective IEC materials are vivid, having an
appealing personality that helps them stand out from other materials. They should
stimulate the target audience with a distinctive look and sound, making them stand out
from the "clutter" of competing materials and messages. Messages and design all must
speak with the same voice — in design, color, text and narrative.
2. Stress the most compelling benefit. Effective IEC materials should address real needs
and problems facing the target audience. The information they provide should be specific
and single– minded. The main message and benefit to the target population should be clear.
3. Generate trust. IEC materials that are simple, direct, and technically correct generate
trust in what they say. Credibility should never be replaced by creativity.; a straightforward
design is a better basis for trust than extravagant or fancy IEC materials. Trust is generated
by tone, presentation, believable images, and a solid information foundation.
4. Appeal to both the heart and the head. A decision on the part of the target audience to
try something new is not made entirely in the mind — trials are often decided in part by an
emotional response. Thus, effective IEC materials and messages should be designed to
appeal to both the heart or emotions, and the head or reason.
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Guidelines for developing new I.E.C materials, or selecting / adapting

existing I.E.C materials
The guidelines for the design and development of new or original IEC materials is, in
essence, the same as that for adapting existing materials. Emphasis must be made in
developing a material that is clear; clear in text / narrative, visuals and format. When
designing new IEC materials, or adapting all or parts of a piece of an existing IEC material,
the following questions should be asked:
Does the material selected fit the audience's learning style (i.e. oral, written, audio, visual,
or audiovisual)?
 Is the content limited to no more than a few concepts?
 Are concepts and messages presented in a simple and organized manner?
 Are appropriate, culturally specific values and beliefs represented in the messages?
 Are visuals, photographs, and images culturally relevant?
 Do visuals, photographs, and images correspond with the message in a way that is
clear to the target audience?
 Is text written or narrated at an appropriate reading/comprehension level?
Answers to these questions must come for the target audience (see Section 5: Pretesting
Draft / Prototype or Adapted IEC Materials). Conferring with the target audience during the
design phase of IEC material production will and ensures that IEC materials and usage
strategies are suitable.
The following guidelines may be useful in adapting IEC materials to become appropriate for
a program and its audience. The questions can help identify specific areas that need
modification — text / narrative, visuals and format. These questions are provided as
examples of issues to be explored through focus groups, in–depth interviews, or other
pretesting methods.
Text / Narrative
1. Examine the draft key message or advice put forward in the creative brief.
Determine whether the proposed material contains too many
Rule of thumb: Include only
messages. For textual material, each paragraph should contain
a few concepts and only
just one message or action. Posters and leaflets should not become information that enables the
cluttered with too much information. Electronic media should not user to follow the message.
be overloaded with too many visual and audio messages.
In examining messages, ask the following:
o Are the proposed messages and supporting information technically accurate?
o Do the proposed messages provide too little, too much, or adequate information for
the target audience?
o Are proposed messages presented in logical order?
o Are the proposed messages or advice feasible for the target audience?
2. Examine how the text or narrative is written.

Rule of thumb: Use short
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sentences and words. Use
active language. Use words
and phrases familiar to the
Text or script should be written with the intended target audience

in mind. Keep it at an appropriate level, based on information
collected during the formative research stage. In short, keep text
and narratives simple and understandable.
Ask the following questions:
o Is the reading level understandable to the intended target
audience?
o Does the information use appropriate local idioms / slang? Is the audience's
preferred language used?
o Are statements community specific?
o Are statements made in an active voice?
3. Determine whether text or narrative matches or corresponds to visuals.
Visuals should complement, not compete with, text or narrative. Rule of thumb: Use visuals that
They should enhance and help clarify the message being delivered. reinforce text and / or narrative.
This is especially true for target audiences with a low– Visuals should make sense to the
literacy level. The following questions need to be addressed: target audience. Visuals and text
o Does the text or narrative clearly describe what occurs in should be clearly related.
the visual?
o Do the visuals compete with or overpower what is written or spoken?
4. Determine whether the message is believable / credible to the target audience.
When developing or adapting material, audience preferences
— uncovered via formative research — be should be taken Rule of thumb: Make messages
into account when fine–tuning messages. The message source believable and practical. Promote
should be known and credible to the target audience. behaviors that are appropriate in the
o In the case of electronic media, is the narrator a cultural, social and economic setting.
Respected peer or credible community member?
o Will the target audience view the message as believable and practical?
o Is the message suggesting a behavior change that is possible for the target audience?
Visuals
1. Decide whether visuals correspond with text / narrative.

Visuals must be culturally appropriate and should enhance the Rule of thumb: Choose photographs
message being delivered, not compete with it. or drawings that are clear and easy to
o Do the visuals correspond to what is said in the text or understand. Use visuals that show specific
narrative? examples of the behavior described. Cartoons
o Do the visuals provide additional information about how and drawings should be life–like. Avoid
diagrams, graphs and other complicated
o toadhere to the message being delivered? visuals.
o Are the visuals appealing, not abstract or cluttered?
2. Illustrate the important points.
Visuals should highlight only the most important points made in Rule of thumb: Limit the
number of visuals in order to
the text, in order not to confuse the learner. emphasize the most important
o Do the graphics or photographs illustrate the most important points. Place them in a logical
concepts? sequence.
o Do the visuals enhance rather than confuse the message?
3. People and places should represent the intended target audience and their
culture.
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For greater impact of the IEC material, members of the intended Rule of thumb: Illustrations and
target audience should be able to identify with the message. symbols should reflect the ethnic and
Visuals can assist in this process by reflecting culture and ethnicity. cultural background of the intended
target audience. Place people in
o Do images of people look like members of the intended
everyday settings, using familiar
target audience? belongings and wearing familiar
o Do geography and setting represent where the target audience cloths.
lives and works?
o Are people shown doing things that are realistic in the lives of
the target audience?
o Are the images familiar and acceptable to members of the target audience?
Format
1. Make materials inviting, visually appealing, and easy to follow.

Especially in the case of low–literacy audiences, if text appears
Rule of thumb: Do not overcrowd
too dense, members of the intended target audience are less
printed materials.Leave space
likely to read it. The placement of graphics and text is very important between text and visuals to allow the
in making material appealing. eye to move easily from one to the
o Are graphics and text clear and easy to read? other. Place related messages
o Is the type big enough to be easily read from a distance (for and illustrations together. Use
posters)? colors appropriate and acceptable
o Is the typeface appropriate for the reader? to the target audience
o Are colors attractive?
o Are people / situations represented realistically for the intended
target audience?
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Section 5: Pretesting Draft / Prototype or Adapted IEC Materials
The pretesting of draft IEC materials is an important Definition: What is pretesting?

step in the development process. Without pretesting, What do we pretest?
IEC materials stand the chance of becoming Pretesting is testing the draft materials or
in-efficient and detached from the needs of the target concepts and messages with representatives
of your target audience before the materials
audience. The materials will reflect the ideas and are produced in their final form.
opinions of people who think they know the audience You should pretest the materials for the
sufficiently enough to decide what material is okay for media; concepts; symbols, and slogans.
them.
When this happens IEC materials are neutralized, or transmits useless information, makes
the wrong appeal, does not motivate, has no persuasive power, cannot modify negative
attitudes, or does not build upon positive existing practices.
Pretesting draft materials can help determine whether the IEC material and message is
acceptable to the intended target audience, the general community, and individuals
charged with using or distributing the material — health workers, VHV and TBA.
People see, hear, and interpret messages according to their various backgrounds,
education, and knowledge. For this reason the IEC material development team cannot
assume that their messages will be perceived the way they intend. If, however, IEC
materials are pretested, revised, and "approved" by members of the target audience, it is
likely that the finished materials will be culturally appropriate, convey the intended
message, and stimulate behavior change. Pretesting of draft IEC material ensures that the
material is "right" from the audience's perspective.
Pretest variables — What to measure

Five variables should be measured during the pretest of draft IEC materials:
Comprehension, Attractiveness, Acceptance, Involvement, and Inducement to Action.
A Note About the Draft Material

 Even though you are pretesting a draft and not the final version of your material, the draft
must come as close as possible to the final version. This way those that are interviewed have
an opportunity to judge a piece of material that closely resembles the final product.
 This point means that if you are pretesting a poster, the draft of the poster must be of the
approximate size as the final poster, have similar colors (markers or washable inks), and have
the same background elements (houses, decorations, trees, or whatever will make up the
context of the final product).
 If the draft material is a radio spot, it is sufficient to do an in-house production of the spot,
which should contain the same elements as the final version. If it includes music, use the same
or very similar music; if several characters are in a dramatic format or in a straightforward
information format, at least gender and age of the voices should be the same; if it contains
sound effects, use the closest possible to the ones you will have in the end product.
 If it is a video spot, ask the producer to give you an animation of the story board, which
consists of taping sequentially the drawings of the story boards.
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1. Comprehension. Understanding IEC materials and messages is essential as a prior

condition
to acceptance and behavior change. Comprehension measures not only the clarity of the
content, but also the way in which it is presented. Complicated or technical vocabulary may
be responsible for the target audience's failure to understand the message. Or, perhaps the
target
audience fails to understand the message because the typeface is too small, making it
difficult for the target audience to read the message.
2. Attractiveness. IEC materials should be attractive. If an IEC material is not attractive
individuals may not pay much attention to it. Attractiveness can be achieved through the
use of
sounds — music, tone — in the case of radio; visuals — color and illustrations — in the
case of
graphics; movement, action, illumination, and animation in the case of video.
3. Acceptance. The messages must be acceptable to the target population. If
communication
material contains something offensive, is not believable, or generates discord among the
target
audience, the audience will reject the message conveyed.
4. Involvement. The target audience should be able to identify with the IEC materials. They
should recognize that the message is directed toward them. People will not pay attention to
messages that they consider do not involve them. Illustrations, symbols and language
should reflect the characteristics of the target audience.
5. Inducement to action. The materials should indicate clearly what the health promotion
intervention wants the target audience to do. Most IEC materials promote a message that
asks, motivates, or induces members of the target audience to carry out or cease a
particular action.
Successful IEC materials transmit a message that can be done by the target audience.
Steps for Carrying out the Pre-test
1. Preparing draft material for the pretest

 Draft scripts, narratives, texts and artwork / storyboards should be prepared based
on
creative briefs.
 Review all draft materials with a technical team / content specialists. Make sure the
technical content of the message has no errors, and is in line with procedures and
processes promoted by concerned agencies.
2. Do an "in–house" pretest
 Even before you go out to the field, you should first make an in-house pretest of the
material, especially with the health education team.
 Check with staff inside the office or based in the field who belong to the target
audience.
 This will help to catch errors before the pretest is taken out to the field, and to
identify comprehension errors. Correcting these errors at this time will allow the
pretest to be narrowed down to the most salient issues.
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3. Determine the sample for those audience segments with whom the material is to
be pretested.
 Make sure the pretest sample has the same characteristics as the intended target
audience. For example, in the case of an IEC material on family planning aimed at
rural women of reproductive age who already have several children, possible
criteria might include women between 25 and 45 years old, married or in union,
with at least two children, and having the intention of not getting pregnant again.
 It is preferable to select several sites having the same characteristics and not
concentrate on a single site.
 After the characteristics of the respondents have been defined, the pretest team can
visit those sites where a large number of such individuals will presumably be found
and select individuals using screening questions.
 While there is no preset formula, experience shows that sample sizes of between 50
and
200 are best depending on the number of audience segments, complexity of the
problem, and the amount of the available budget and resources required. It is,
however, always better to pretest materials using a well-selected sample, even if it is
very small (20-30 persons), than to not pretest at all.
4. Select techniques and design guidelines / instruments to be used in the pretest
 The pretest may be conducted individually or in groups.
 Design pretest focus group guidelines or individual interview instruments.
5. Select and orient interviewers
Note: It is advisable for those people
 Persons conducting the pretest should be
who have produced the materials to have
experienced. If such individuals don't
a role in their pretests. Their exposure to
exist, then outside staff may need to be
audience reaction to their material can be
contracted. These may include university very persuasive in demonstrating the value
staff and students, or research specialists of pretesting.
from NGOs.
 Interviewers must understand that the IEC materials to be pretested are only drafts,
and that the IEC material development team will not be hurt by "negative" pretest
results.
 The instrument to be used in the pretest should be explained to the interviewers.
Instructions should be provided regarding the criteria for selecting those to be
interviewed and the use of a screening questionnaire. Procedures to be followed in
conducting the pretest interview when done individually and when done in focus
groups should be explained. Interviewers should practice first among themselves in
training.
6. Test the pretest guidelines and instruments
 It is also advisable that the pretest instruments be tested to assess whether they will
achieve the pretest objectives and whether they are easy to implement.
Interviewers should conduct three or four interviews and subsequently analyze the
results with the person in charge. For focus groups, a single trial focus group to test
both the guidelines and the proper implementation of that focus group should be
sufficient.
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7. Make the necessary logistical arrangements

 The IEC material development team will need to organize logistics, such as
transportation, meeting places, permits, and authorizations so that everything will
be clearly understood before the initiation of field work.
8. The pretest process.
 Conduct the interview by using the instrument for pretesting that was developed by
the IEC material development team.
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Section 6: Assessing Pre -Test results and revising I.E.C materials
It is safe to assume that if 70 percent of the target audience understands the IEC material
and message, would consider taking the action recommended, and finds the IEC material
attractive, acceptable, and believable, then the materials are successful. However, if the IEC
material is understood or accepted by less than 70 percent, the IEC material development
team must consider making changes to the design of material and message.
There are no absolute guidelines to accomplish this. The IEC material development team
must look for a balance among all the criteria used to measure the effectiveness of the
material.
Changes in Materials
The changes most commonly suggested by the pretest have to deal with changes or
modifications of either the form or the content.
Form
 Music: make rhythm, tempo in accordance with content and tone of message.
 Color: improve combination, tone, intended impact, intensity.
 Tone of the message: place more or less emphasis on emotional content.
 Typeface used: make darker, bolder, bigger, higher or lower in contrast.
 Eliminate distracting attention overload.
 Make more accurate representation of persons or things (proportion and
perspective).
 Rearrange text and visual distribution of elements.
 Change names, roles, or personalities of characters.
Content
 Change words that cannot be understood.
 Give greater clarity to what the target audience is supposed to do.
 Express a single idea and eliminate superfluous information.
 Avoid using abstract concepts or figures that the user may not relate to the message.
 Make the benefit stand out clearly.
 Change technical terms that are obscure, confusing, unnecessary.
 Clarify concepts that were thought to be clear.
 Make the behavior easier to grasp, simpler to understand, more appealing to try.
Some changes may be minor and unimportant. It may well be decided that they do not
merit the trouble (high expense, too much time, or any other additional reason required to
make changes).
Number of Pre-Tests
There is no set rule for the number of pretests to carry out. As the IEC development team
becomes more familiar with pretesting dynamics, however, a feeling for the number of
pretests required will be developed. In actuality, the number of focus groups or individual
interviews will to a certain extend be determined on the basis of budget and resources. In
general, however, the number of pretesting sessions per IEC material is dictated by the
nature of the material to be pretested and by how well the first draft answered the pretest
variables as perceived by the target audience. By the second focus group, or in the case of
doing individual pretesting, when the first round of 10 people is interviewed, interviewers
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should stop and collect the overall information thus far gathered and ask the following
questions:
o Is there a clear rejection of the material? If so, why?
o Is there a general consensus that the material is ugly, culturally insensitive? If so,
why?
Is there a gross incomprehension of words, of a specific drawing, symbol? Which ones?
Why? If
so, which can be changed according to the suggestions given, so that interviewers can
continue with further pretesting interviews or focus groups?
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Section 7: MONITORING & EVALUATING THE HIV & AIDS PROGRAM
Monitoring:
Monitoring is often seen as an obligation imposed from outside, with project staff and
volunteers mechanically completing forms and registers and the project managers
seeing the task as a mere collection of data for writing up reports for donors. This is
not true…
Monitoring is a continuous process which involves collection of data, which when
analyzed can indicate progress or constraints. Monitoring is concerned with
establishing whether activities are being carried out in a manner planned, and also in
determining if the project needs to make any changes in its strategies for success.
Monitoring deals with input, process and output.
Monitoring is an activity that involves peer educators, coordinators and the funding
organization in closely keeping track of the performance of the program in relation to
achieving the initial objectives.
Example: Cooking Rice

We look at:-
 Inputs; rice, water, oil, fire, person, salt, sufuria……
 Process; light fire, boil water, sort rice, boil rice, stir salt, watch water level, taste,
regulate fire….
 Output; ready food…
Evaluation:
Determines how successful the project/program has been meeting its objectives, as
well as assessing the impact of program activities on desired outcomes e.g. behavior
change over a period of time. It informs managers whether they are moving towards
or away from their goals and why. Evaluation deals with outcome and impact.
How do we evaluate cooking of rice?

We look at:-
 Impact; no hunger, good health, no medical bills, happiness, stable economy…
NB: Mid-Term Assessment of rice is important to see if one is heading towards the right
direction or make changes before its too late.
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Importance of M & E:
• Informs us if project and its activities are being implemented as planned
• Helps to identify if there are enough resources
• Helps to identify problem areas and correct
• Helps to identify what is working well
 Determines effectiveness of a project
 Whether the project achieved desired goal
 Whether project achieved more than was planned
 Whether the same or similar types of activities should be replicated
elsewhere
How do we monitor and Evaluate HIV and AIDS programs?

In order for us to Monitor and Evaluate activities, we need data to inform us on the status
or direction things are headed
Focused indicators are used to help answer or measure progress or status or
achievements.
What do we monitor?
Monitor input: This refers to a set of resources required by the project such as;
• Funds
• Supplies/materials e.g. test kits, needles, gloves
• Equipments e.g. lockers
• Staffing
Monitor process: This is a set of activities through which program inputs are utilized in
pursuit of expected project results. e.g
• Staff training
• HIV testing
• Client counseling
• Treatment
Monitor output: These are results obtained through project activities using given inputs:
e.g
• # staff trained
• # clients receiving VCT
• # condoms distributed
• # test kits consumed
• # clients served in PMTCT
Evaluate outcome: These are the short-term effects/results of the project e.g
• Improved provider skills
• Risk behavior
• Improved community attitude on PLHA
• Enhanced quality life
Evaluate impact: These are the long-term effects/results of the project mainly
experienced by the beneficiaries like the community.
• Mortality rate
• Economic impact
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• HIV incidence/prevalence
• STI incidence/prevalence
Who needs the M & E results?
• Top Management
• Program/Project managers,
• Project staff (health providers) and volunteers
• Donors.
All these players require monitoring as well as evaluating the projects performance in
order to achieve the expected results and help make informed decisions about the future.
Importance of Quality data Gathering:
Without accurate and consistent data, monitoring and evaluation would be in vain. We
need to validate data in order to have accurate results. In order for data to be useful, it also
needs to be timely. This would allow timely actions to be taken.
Qualitative or Quantitative Monitoring:

1. Quantitative Monitoring:
Tens to document numbers associated with the program. Includes:
 How many condoms were distributed this month
 Ho many peters were distributed the period
 How many Peer education sessions were held
 How many referral sessions were held
 How many times the program was on air
It focuses on which and how often behaviour Change communication elements are being
carried out. It involves record keeping and numerical counts
2. Quantitative data
These are defined in numeric terms including percentages, averages and increases/rises.
Quantitative data answer questions such as how many and how much and are best
gathered through the monitoring forms, surveys and medical records.
The quantitative indicators could be seen in:

a) The increase in participation in Peer Education sessions and usage of resource
centres by peers (increase in health information seeking)
b) The rise in condom uptake
c) Increase in reported condom use
d) The rise in number of peers seeking VCT, STI diagnosis and treatment, Counselling,
and other health services
e) The rise in number of people sharing their HIV status with Peers whether positive
or negative.
3. Qualitative data:
It answers the question on how well the program elements are being carried out. It
answers questions on:
 Attitudes on abstinence, fidelity and condom use
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 Influence of BCC activities on peoples behaviors

 How information permeates the risk community
 Quality of BCC sessions by peer educators and other program persons
It involves qualitative methods, such as in-depth interviews and focus group discussions or
observations. Reported behaviors also form a bulk of these qualitative indicators
4. Qualitative Data
These can be best described in terms of perceptions, implications, feelings, opinions and
reasons. Qualitative data address why and are gathered through group activities, one-to-
one talks and in-depth interviews.
The qualitative indicators could be seen in:

a) The level of questions (are rhetorical, knowledge based or personal)
b) The level of experiences shared: Are they spontaneous or coerced- how free are the
peers in sharing personal experiences and how personal are the experiences
c) The quality of answers coming from peers- shows an increase in the level of
knowledge.
Monitoring the use and impact of I.E.C materials
Monitoring of IEC materials refers to the review and supervision of distribution and usage
activities.
Findings are used to improve distribution systems, the use of materials by health workers,
and the future design of materials. Monitoring is a tool to identify and correct problems
early enough to make changes and maximize the impact of the IEC materials.
What does monitoring do for you?

 It shows you what links in the delivery system are not functioning as expected.
 It reveals if the materials have been delivered in time, to the correct people, at the
correct place.
 It lets you correct the delivery plan when you find it is in error or inadequate.
 It reveals if sites where materials are displayed need to be changed.
 It shows if broadcast media should be aired at more appropriate times
 Distribution of print materials. Are posters up, but not where the target audience
can see them? Have flip charts reached the health centers where the health workers
have been trained in their use?
What should be monitored?

 Mass media broadcasts. It is important to be sure that radio and television spots are
actually broadcast on the days and times with the frequency and in the order agreed
upon. This requires individuals to monitor mass media —listen to the radio stations
or watch television during the time slots contracted.
 Exposure. Are the numbers of target audience that were predicted actually hearing
radio spots? Seeing the posters? Or watching the television announcements?
Interim Effects
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Monitoring can also be used to look at the interim effects of using IEC materials in support
of a
health promotion program. If materials are properly designed and used, a change in the
following should be recognized.
Knowledge. Does the desired percentage of the target audience can recall the key
messages presented in the IEC materials? If not, messages may need to be broadcast more
often, on other stations, or at a more appropriate time. Likewise, print materials may need
to be more widely placed.
Reaction. Is there evidence that the target audience is reacting negatively to the messages
or the behavior promoted by the IEC material? If so, it may be necessary to change certain
factors in the messages, or in the broadcast schedule.
Target Behavior. Assuming knowledge is high and reaction positive, begin to look at
changes in behavior for the target audience. The reporting of target behavior is included in
monitoring in order to provide timely feedback with regards to the impact and effect of the
IEC materials.
Monitoring is done in many ways using multiple forms of follow-up. Among the most
common
methods are the following:
 Regular audits of materials at distribution points.
 Listening to broadcasts to ensure media messages are aired at the contracted hours.
 Regular field trips to health centers and hospitals to check on availability of IEC
materials.
 Observations at service health centers and hospitals to check usage of materials.
 Focus group discussions to investigate the impact of promotional messages and to
detect possible confusion.
Why Monitoring?
Monitoring helps programs to be successful and Peer Educators to be proud of their work.
It helps answer some questions like:
 How well is the Program working?
 What might be some of the problems the program is experiencing?
 How best can we solve these problems?
 How far has the organization gone in knowledge, attitudes and behaviours?
 What else do we need to add to our program to make it comprehensive/better
Other reasons for monitoring are:

To measure that activities are completed and targets are met.
i. Monitoring the progress and achievements of the programme as it is implemented
creates accountability by making sure that the activities involved take place as
planned.
ii. It also ensures that the activities reach their targets (such reaching a certain number
of peers in certain duration).
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iii. It makes sure that sufficient data are collected for the final outcome evaluation.
To determine the outcome of the program:

i. A structured evaluation would be handy in creating perceptions about the effects/
impact of a program.
ii. However, informal feedback and other anecdotal evidences from employees and
community members can also offer such perceptions.
iii. It is essential to know whether or not the program has an impact and either change
its focus or justify its continuation
To adapt strategies as needed

Monitoring and evaluation allows staff to examine which program components were
most successful and which need improvement, and adapt programme strategies in
order to reach their goals more appropriately.
To get such information, Peer educators and focal persons fill out reports and hand them to
the appropriate coordinator after the session (mostly on weekly basis). The forms are then
analyzed to answer the above questions
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SAMPLE ICE BREAKERS & INTRODUCTORY GAMES
1. Coconut
The facilitator shows the group how to spell out C-O-C-O-N-U-T by using full movements of
the arms and the body. All participants then try this together using a rhythm of a common
song to make it possible to change speed each time you repeat the exercise.
2. Dancing on paper
Facilitators prepare equal sized sheets of newspaper or cloth. Participants split into pairs.
Each pair is given either a piece of newspaper or cloth. They dance while the facilitator
plays music or claps. When the music or clapping stops, each pair must stand on their sheet
of newspaper or cloth
The next time the music or clapping stops, the pair has to fold their paper or cloth in half
before standing on it. After several rounds, the paper or cloth becomes very small by being
folded again and again. It is increasingly difficult for two people to stand on. Pairs that have
any part of their body on the floor are ‘out’ of the game. The game continues until there is a
winning pair.
3. Find someone wearing...
Ask participants to walk around loosely, shaking their limbs and generally relaxing.
After a short while, the facilitator shouts out “Find someone...” and names an article
of clothing. The participants have to rush to stand close to the person described.
Repeat this exercise several times using different types of clothing.
4. Football cheering
The group pretends that they are attending a football game. The facilitator allocates specific
cheers to various sections of the circle, such as ‘Pass’, ‘Kick’, ‘Dribble’ or ‘Header’. When the
facilitator points at a section, that section shouts their cheer. When the facilitator raises
his/her hands in the air, everyone shouts “Goal!”
5. Fruit salad
The facilitator divides the participants into an equal number of three to four fruits, such as
oranges and bananas. Participants then sit on chairs in a circle. One person must stand in
the centre of the circle of chairs. The facilitator shouts out the name of one of the fruits,
such as ‘oranges’, and all of the oranges must change places with one another. The person
who is standing in the middle tries to take one of their places as they move, leaving another
person in the middle without a chair. The new person in the middle shouts another fruit
and the game continues. A call of ‘fruit salad’ means that everyone has to change seats.
Page 50
6. Group statues
Ask the group to move around the room, loosely swinging their arms and gently relaxing
their heads and necks. After a short while, shout out a word. The group must form
themselves into statues that describe the word. For example, the facilitator shouts “peace”.
All the participants have to instantly adopt, without talking, poses that show what ‘peace’
means to them. Repeat the exercise several times.
7. Killer wink
Before the game starts, ask someone to be the ‘the killer’ and ask them to keep their
identity a secret. Explain that one person among the group is the killer and they can kill
people by winking at them. Everyone then walks around the room in different directions,
keeping eye contact with everyone they pass. If the killer winks at you, you have to play
dead. Everyone has to try to guess who the killer is.
8. Move to the spot

Ask everyone to choose a particular spot in the room. They start the game by standing on
their ‘spot’. Instruct people to walk around the room and carry out a particular action, for
example, hopping, saying hello to everyone wearing blue , walking backwards, smiling at
ladies only, etc. When the facilitator says, “Stop”, everyone must run to his or her original
spots. The person who reaches their place first is the next leader and can instruct the group
to do what they wish.
9. “Prrr” and “Pukutu”

Ask everyone to imagine two birds. One calls ‘prrr’ and the other calls ‘pukutu’. If you call
out ‘prrr’, all the participants need to stand on their toes and move their elbows out
sideways, as if they were a bird ruffling its wings. If you call out ‘pukutu’, everyone has to
stay still and not move a feather.
10. Taxi rides

Ask participants to pretend that they are getting into taxis. The taxis can only hold a certain
number of people, such as two, four, or eight. When the taxis stop, the participants have to
run to get into the right sized groups. This is a useful game for randomly dividing
participants into groups.
11. Tide’s in/tide’s out

Draw a line representing the seashore and ask participants to stand behind the line. When
the facilitator shouts “Tide’s out!”, everyone jumps forwards over the line.
When the leader shouts “Tide’s in!”, everyone jumps backwards over the line. If the
facilitator shouts “Tide’s out!” twice in a row, participants who move have to drop out of
the game.
Page 51
Appendices
Carrying out Introductory games
1. The mysterious Objects
Resources:
You require objects, in or just outside of the room. If no objects are “naturally available,
you may choose to bring a bagful of everyday objects into the room and spill them onto a
table for participants to choose from.
Duration: 60 minutes
Process:
1. Ask participants to form teams of two, finding a partner whom they don’t know at
all, or do not know well.
2. Each team member should briefly introduce themselves to their new friend, stating
their name and where they come from.
3. They should then find an object, either inside the room or outside of the room,
which they feel symbolizes their region, their community or their place of work.
4. Ask them to identify an object in five minutes and put it on a table.
5. Ask each team to introduce themselves and to explain why they chose this object as
their symbol.
2. Introductory Bingo: The Signature Game
Method: participatory game

Duration: 15 Minutes then continuous to the end of the training
Process:
1. Tell the participants that we are going to introduce ourselves by names, the
departments/section/units of affiliation
2. Distribute the Signature forms as in the table below to each participant and tell
them to identify the individuals described in each of the boxes and ask the
individuals in the group to sign for them under each of the descriptions
3. Leave the participants to continue with the game and call the game to a stop after 15
minutes
Page 52
Handout: The signature game sheet

Find three people Find someone with a Find someone of Ask someone
with hair style you birthday in the next the same religion why she/he is
like. three months. as you. attending the
Sign: _________ Sign ___________ Sign ________ workshop. _____
Find someone with Someone who is Find someone Shake hands with
arms always always smiling with an earring. one person.
crossed. _______ Sign:__________ Sign: ________ Sign: _________
Swap sitting Find someone with Find someone Find someone

positions with brown eyes. who is prepared taller than you.
someone. Sign: __________ to take risks. Sign: ________
Sign: __________ Sign: ________
Find someone with Find someone Find someone Ask someone

black socks. younger than you. who likes why she/he is
Sign: __________ chocolates. attending the
Sign: _________ Sign: _________ workshop.
Sign: _________
Find someone with Give someone a hug Find someone Find someone
a long nose. who is prepared who is planning
Sign: __________ to take risks. to marry.
Sign: __________ Sign: ________ Sign: ________
Find someone who Find someone who Someone who’s Someone with
is single and has provided for care first letter of first whom you share
seriously searching for a person living name is similar to months of birth
Sign: _________ with HIV yours: Sign: ________
Sign: __________ Sign:_________
4. Ask the participants:

a. How easy was it to get the persons described?
b. Did each person get all signatures in each box
c. Which instruction did you find difficult?
5. Explain to the participants that they will continue getting the signatures till the end
of the training workshop
Page 53
3: My Picture of inspiration
Resources
Pictures, in or just outside of the room placed on the floor in the training room for
participants to choose from.
Duration: 60 minutes
Process
1. Ask participants to form teams of two, finding a partner whom they don’t know at
all, or do not know well.
2. Each team member should briefly introduce themselves to their new friend, stating
their name and where they come from.
3. They should then find a picture, on the floor inside of the room, which they feel
symbolizes their region, their community or their place of work.
4. Ask them to identify the picture in five minutes and hold it out for all to see.
5. Ask each team to introduce themselves and to explain why they chose this picture
Page 54

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I.E.

C MATERIAL DEVELOPMENT TRAINING

Understanding the Peer concept ..........................................................................................................................5

The National Organization of Peer Educators (NOPE) is a Kenyan organization established in

Currently, NOPE’s workplace clients base is over 51 organizations reaching a combined

Value-based experiential learning principles guide the delivery of training of volunteers.

UNDERSTANDING THE PEER CONCEPT

Who are Peers?

What is Peer Education?

Table: Types of Peer Led Approaches:

Peer Information Peer Education Peer Counseling

Example of IEC material Continuous group Counseling peers living

RATIONALE FOR PEER EDUCATION

 Employees young people and  If peer educators outgrow their

THEORETICAL BASE FOR PEER EDUACTION

Theory Application in Peer Education

A person’s normative beliefs, that is, how a

Tell me… I forget, Show me… I remember…. Involve me…I understand.

Diagram: The cycle of experiential learning:

Participants participate in:

Participants Discuss: Participants (trainees) participate in:

Trainees participate in:

HARVESTING, SORTING AND ANALYSING QUESTIONS FROM PEERS AND

The role of questions in the dialogue process:

Questions build community ownership of information: This is especially when the

Promote a culture of questioning selves and others: Questions develop community

How are questions harvested?

Category of Significance Example

The quality of questions:

Relating Harvested questions to the Behaviour Change Continuum

Possible feeling/attitude Type of question

Developing sessions from Questions from Peers:

Type of question Action by Peer Educator

Behavior Change Communication (B.C.C) Strategy

Behavior Change Communication

The Strategic Role of Behavior Change Communication

The Goals of Behavior Change Communication

 Increasing the adoption and continued use of safer sex practices;

Summary of Behavior Change Theories

SETTING PROGRAM, & BEHAVIOUR CHANGE COMMUNICATION (B,C,C)

What is the Role of B.C.C in HIV & AIDS Programs?

B.C.C Guiding Principles:

Why Behavior Change is a slow process:

• Fear of the unknown: How ideas are presumed risky until …

B.C.C in Support and Care:

How to target behavior with B.C.C programs

Those seeking care

Addressing Stigma through B.C.C

What B.C.C cannot do :

Essential steps to develop a Behavior Change Communication Strategy

Step 1: Identify the problem based on the overall program goals.

B.C.C Impact Indicators

Approval – Responds favorably to messages, discusses messages or issues with members of

Practice – Goes to a provider of information/supplies/services, chooses a method or practice

Towards Strategic Behavioral Communication, more than just B.C.C

SBC’s Guiding Principles

 Be applied across entire program in a consistent, complementary fashion, so its messages,

 Be designed and implemented in a participatory fashion to involve all relevant beneficiary

 Be based on evidence by assessing the perceptions, levels of knowledge, attitudes, beliefs,

 Be built on quality assurance/quality improvement, meeting established quality standards

 Be responsive change through feedback, even after implementation has begun

Redefining Behavior Change

What Can SBC Do For HIV & AIDS Programs?