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    Communication Communication process Sender ~ Receiver = Cues to action Message = self-efficacy ~ Chalk and tk (ect = Encodin = Reinforcement = Symposium i) * Decndiig = Social behavioral change a cot ee = Feedback communication (S8CC) Panel cision ~ teartibiatiecies = Five -planning steps = Workshop [Barter of communication = key strategies of SBCC = Conferences or seminay Rehavers change communication = Seria mobization = Role playing/sociodran ~ 4H D Rhavior change comrunicston aaa celieneiaian > Human behavior (acc) = Television nan een = Health promotion = Radio ~ Perceived susceptibility = Ottawa charter = Print material = Museums Perceived severity INTRODUCTION TO COMMUNICATION Before starting to discuss behavioral change communication (BCC), let us review the communication process, barriers and measures to overcome. It is vital for nurses to have great communication skills. Community health nurses uses ‘communication” as one of the pillars to interact, promote, prevent disease and rehabilitate. Communication skills of community health nurses enhance their services to community. People communicate through various ways. Usually tly face to face. ‘Traditionally men people converse direct iting letters and used only postal communication (like wr sending telegrams) and it was the only mode, those days, In the world of advanced technology, we use telephone, mobile phone, email, skype, WhatsApp, viber, etc. Man cannot stay tn isolation. In current world of technology, most people use ‘electronic modes through various interfaces. ‘The word ‘communication’ comes from the communicare” means ‘to share: Communication is the 4 ‘of information between two or more individuals or within the group and the purposes Vary. Latin word COMMUNICATION DEFINITIONS Communication isthe process of initiating, transmitting ‘and receiving information a amunication i the process of sharing information, eas and atinudes between individuals, é¢ Ba Comprehensive Textbook of Community Health Nursing for y Perceived benefits Perceived barriers Health promotion * Nunn Health maint fenanes Health education Audiovisual aids Communication is a process through which ‘mutually exchange their ideas, values, india, ‘and actions with one or more people. MS ag COMMUNICATION PROCESS ‘The process of communication is made up of the flovsg seven basic parts: 1. The sender is the person (or persons) conveying, message. 2. The receiver is the person (or persons) to whom ie message is directed and who is its actual recipient. 3, The message, which is an expression of the purpoed communication. Without the message, there can be» communication. 4, Encoding which refers to the sender's conversion ote ‘message into symbolic form. This involves how these translates the message to the receiver. 5, Channel, or the medium through which the senke ‘conveys the message. The channel may be a wien spoken, or nonverbal expression. 6. Once the sender has conveyed a message through channel, the receiver must translate the message it understandable form, called decoding, 7, The final part is a feedback loop, which refers 0 & receivers indication thatthe message has been unde (decoded) in the way that the sender intended (neo? It requires feedback from the receiver to the sendet spn > [Bleed | | vere f to Feedback loop rig. $1 Communication process ' pES oF COMMUNICATION mv ee sjcation is based on the Following types Co the means of delivering the message pased on Jhe purpose of communication * pasedon't » Medon the levels of communication prs onthe pattern of communication onthe Means of Delivering the Message communication spispe of communication takes place face to face. I alo ‘rough phone, email, video conferencing, etc. Several os pay to convey meaning, nonverbal Communication inthis, communication occurs without words; all five senses ie ole range of body movements, posture, gesture, facial and silence are the methods used at both the Sa Nonverbal communication speaks louder than verbal jon because it conveys the true and intended ‘penning of the message. Nonverbal communication may be ‘complished by the following means: Touch, eye contact, facial expression, posture, posture, gait, gesture, physical appearance, silence. Based on the Purpose of Communication © Formal communication: Follows lines of authority ‘occurs in organizations. * Informal communication: Informal communication oes not follow line of authority. This is also known as sgrape-wine communication, i.e: families, peer groups, g0ssips in the office, etc. Based on the Levels of Communication Intrapersonal communication: It takes place within an individual; we may also say it is self-talk. Interpersonal communication: In this, two or more ioe interact or exchange messages or ideas. It is one of commonest forms of communication. Small-group communication: A person communicates to a small group, Pubic communication: A person speaks to larye sro¥P of people Based on the Pattern of Communication * One-way communication (Didactic method): The communication flows from a sender to audience. The eceiver has no role other than listening hence, n0 feedback. It is actually authoritative learning where knowledge is imposed, eg, lecture method. ‘Two-way communication: [n this, both the communicator and audience take part. Active learning occurs. The audience may raise questions and add information, ideas and opinions on the subject. BARRIERS OF COMMUNICATION Physiological Barriers Poor retention due to memory problem Lack of attention due to illness Poor sensory perception Poor listening skills Information overload ee eee Psychological Barriers Misunderstanding Emotional disturbances Psychotic or neurotic illness newt Fear, anxiety Language and comprehension difficulties Environmental Barriers Noise Poor lighting Uncomfortable seating Invisibility Unhygienic surrounding and bad odor Very hot or cold room © Congested or over crowded rooms Sociocultural Barriers Economic and social class differences, levels of understanding, knowledge, attitudes, beliefs, economic and social class differences, language variations, cultural difficulties between the foreigners and nationals. ; ‘ocess-Related Barriers Sender has poor public speaking skills * Unclear and conflicting message not meeting the audience need Stereotypical approach © Inap cls “ea indition of sender health status or METHODS TO OVERCOME THE BARRIERS OF COMMUNICATION aes Methods to Overcome Physiological Barriers * Keep in each other's retention and recollection abilities * Pay attention during the sharing of information ‘© Ensuring the comfort of both the sender and receiver © Ensure the intactness of sensory perception © Avoid information overload Methods to Overcome Psychological Barriers © Maintain rapport with the audience © Develop trust and win audience © Do not give room for negative emotions © Avoid feeling of prejudice, resentment and antagonism Be free from fear and anxiety Methods to Overcome Environmental Barriers * Comfortable seating arrangement © Ensure good lighting to facilitate nonverbal communication «Provide noise controlled hygienic environment. Ensure air circulation if air-conditioned halls maintain optimum levels ‘© Enrolling the correct number of audience corresponding to the hall/room. Methods to Overcome Sociocultural Barriers © — Give due consideration to social and cultural differences; Individual values and behavior must be respected. Be patient and an active listener Show unbiased respect to all Social beliefs must be kept in mind Methods to Overcome Communication Process-Related Barriers ‘© Design appropriate message relevant to audience © Be physically fit = = Maintain time we Textbook of Community Health Nursing for pe Ben Nur tng np the following public speaking yy hy mmunity health nurses important t PUBLIC SPEAKING SKILLS ayy COMMUNITY HEALTH NURSEO Public speaking is one ofthe greatest hep, from your time in your nursing You student will be required to oul ae As colleagues and disciplines on a wide range et 5 i) F patient care and evidence-based students need to be confident and tad detailed structured arguments to those wha, Speaking in public can be daunting Tight ng nervous atthe thought of talking to peers in Ke) ‘This is a natural response and. one should not po fy it. Most great speakers are nervous of the: orig in public. As one good presentation is ae ‘ gain in confidence, the nerves will reduce sad hy ain aba eer ths, -- Verbal Communication Van Emden and Becker (2004) suggest that you the following questions: 8k Yang Is my voice loud, perhaps too loud? Is my voice soft, perhaps too soft? Do I speak too slowly? Do I speak too quickly? Is my voice monotonous? Do | articulate clearly, or do I mutter? Will my accent cause my audience difficulty? : a © DoT run out of breath or gasp for air as I speak? This is very much important for a community health max since she moves with people/general public and lives wit people. Communication is the vehicle through whic fe community health nurse can reach the heart ofthe pert and win their confidence. Community is not a fourvalld building like hospital where patients come to us for theiteze Community is the house of people where the commsiy health nurse knocks at the doors of the people. q eee eee é Volume Speaking loudly gives you an advantage in that your, will be able to hear you. However, speaking !00 seen as being arrogant or aggressive and that an audience ‘off’ Speaking too softly, on the other hand Pe problems It is much more likey that you wil -_ . a, communication Management and Health Education High ‘Yielelrrce ome TT) rt ten ne nay so somty tmnt Your auidience determining the meaning of client behavior. Health seeking v1 This is often caused by a lack of confidence behaviors are those activities directed toward attaining and For nurses this can be a major problem, 1 ple to relate information in an easily erative. Misheard information can have | nd even fatal consequences, you in M9 «not easy YoU need to help your audience by ag Mow and meaning are coherent. are the fl normally the result of inexperience and/or be attributed to your state of mind before you .o quickly will short-change them and leave that they have wasted their time. sng fast 15 Thiscan ves Speaking 10 speaking swith a sense tbe ocal Accents hne local dialect and generational differences in the same words may mean different things the age of the audience and where they come rare of t ‘peaware audiences Gepending on fro". Nonverbal Communication, in Reality, Refers goBody Language and looking confident gives the audience the “on that the nurse is comfortable being there and she Jarsomething important and interesting to say. BEHAVIORAL CHANGE COMMUNICATION SKILLS a Definition “Behavioral Change Communication (BCC) is an interactive with communities to develop specific messages methods using a variety of communication routes or “pathways to develop positive behaviors; promote and maintain vidual, community and societal behavior change. IMAN BEHAVIOR Itis important to know the health behaviors of people in to understand its influence on their health. Behavior defined as the observable response of an individual to stimuli, The nurses must know that every human has a meaning. Behavior is the individual's attempt Achieve satisfaction of needs. Nurses must sometimes act investigators to determine the need(s) underlying client maintaining a state of well-being Variables Influencing Health Behaviors Many theories and health care related models have expressed various factors influencing the human behavior. In general ‘many variables influence human health behavior. Some most prominent variables influencing health: Lifestyle Individuals determine their health status through their actions, Lifestyle consists of a person's usual daily activities and routines that are acceptable practices in the person’ life. Such routines and habits influence health status. For exanggle> smoking and a sedentary lifestyle negatively affect health status, Locus of Control Locus of control refers to individuals’ sense of being able to influence events and situations affecting their lives. People with internal locus of control are more willing to make lifestyle changes that lead to wellness. Self-Efficacy Bandura (1977) used the term self-efficacy to describe an individual's perception of one's own ability to perform a certain task. Self-efficacy is a form of self-confidence that leads to successful behavior performance. Health Care Attitudes Beliefs are powerful influencers of behavior. Health behaviors are based on beliefs, attitudes about health and personal vulnerability. Societal values also contribute to this. Self-Concept Self-concept is an individual's perception of self. It includes self-esteem (an individual’ perception of self-worth) and body image (perception of ones physical self). The relationship between self-concept and health is strong. Self-concept is ‘dynamic and may change according to health status. Not only does self-concept influence health, but changes in health status may also influence self-concept. = MODEL According to Fawcett (1992), a model is a set of concepts and the assumptions that integrate them into a meaningful configuration. Comprehensive Textbook of Community Health Nursing for age Perceived Barriers Concepts and Definitions in Health Belief Model (HBM perceived barriers refer to Dells concerning s of following the the Health belief model has the following constructs (Fig. 5.2); gined costs of f ig the new beh ety ee imaareve that anew action is effectiveinggn, ng [Perceived susceptbiy | aeptibiity or perceived severity ofthe cing hg ma 7 sinsider the action to be expensive, inco ee a ‘Serie eee Seer |) [Reema] paint or upsetting (Rosenstock, 1974 — res) | | teercees, P . SS ability to carry jo Cues to Action specie action Jrecommended eT aa | ,Oucamonal pose!) ‘The precipitating forces that make a person fee th ‘action action, Such cues may be internal (e.g, deg — state) or external (€g. interpersonal in tion Steg media communication, or receiving remiadaeeae Fig. 5.2: Health belief model tunity health nurse or the doctor fora follow-up, as Self-Efficacy Perceived Susceptibility The HBM has six constructs, the first one is perceived a susceptibility. This refers to the subjective belief that a It is the extn ee person basin his heat, person has with regard to acquiring a disease or reaching @ pursue a behavior. It is behavior specific and isin thy = harmful state because of indulging in a particular behavior, and not about the past CE Sa Individuals vary considerably with regard to their perception ‘The HBM is widely utilized to explain dif ’ ‘iiness or harmful condition. _ short-term health behaviors: 7 © Preventive behavior of susceptibility to any given Peoples beliefs on perceived susceptibility could be one of ‘© Illness behavior the following: eee doadals who completely deny any possibility oftheir 6 Sick role behavior acquiring the disease eee etne may admit to the possibility ofacquiing Be ways TO INFLUENCE BEH: disease, but believe it is not likely to happen to them. |AVIOR: Itis not possible to change behavior just in a day. Hower People who are so fearful of acquiring the disease and believe they have all probability acquiring it. The MOF change can be influenced using various susceptible a person feels, greater the likelihood ofhisor | cg approaches: her taking preventive measures. Support: Providing a service support and: what they need, want, or value. When people ae notin need of something they probably do not value it. So messages what we want need to correspond with need, availability and in advance. Inform: Inform, advice, build awareness, encourage, persuade and inspire people to adopt Perceived Severity Perceived severity, which refers to a person's subjective beliefin the extent of harm that can result from the disease or harmful. state as a result of a particular behavior. This perception also varies from person to person. The constructs of perceived = ‘2 severity and perceived susceptibility together is known to be behavior. Providing the needed information 2 perceived threat. to correct people whose needs are matching wih tt information value a lot. © Legislation: Legislate, regulate, enforce with gc The thipd construct of the HBM te peretved benefits which fotee Peoble tm sep beala iaaas Soe refers to belief in the advantages of the methods suggested following COVID-19 prevention rules (Wearag for reducing the risk or seriousness of the disease or harmful social distancing and hand washing), wearing eis state resulting from a particular behavior. The relative ® Design: Set environmental and physical cone effectiveness of known available alternatives plays a role in availability, and distribution of infrastructure i ‘way that people are enabled to take action. shaping actions. Perceived Benefits > of BEHAVIOR CHANGE PS sé nate knowledge, le knowled ts of health workers, — gains knowledge, I 8 about a new and understands meaning of wes the new behavior and responds subsequently, he discusses the inj Positively formation ral network (Professional, colleagues, family ancy ser he himself approves the practices what he he ots) fre sd gention r he believes this behavior is benefici ‘al to him and 1 ward to consult the provider. He recognizes thatthe mes coon a can meet personal need and intends to adopt these practice rson reaches the provider of information/supplies! a He then attempts new behavior and continues to sdoptand practice advocacy 4s 2 satisfied practitioner who already had practiced the behavior, promote the new behavior in his social or srofesional networks. He acknowledges the personal benefits eé adopting the behaviors, advocates it to others, and supports ‘heprogram in the community. For example, an obese person develops habit of regular 30 minutes’ walk, which helped tim in diabetes and reducing his weight, wil tell other obese ffendsfamily members to adopt the same. TECHNIQUES OF BEHAVIOR CHANGE Sateen cI da IIS OO * Information: Information is provided to people assuming tlt the audience lacks information, Sender or the 'nlormation provider fully dominates it, soit is one-way communication, * Education: The main focus here is on applying what is Skill building techniques, like demonstrations, Practice, learning by doing are useful methods to nication Management and Hog) ¢. Communic lealth Educatig eR tion, FVE8 as the driving f Dies o ttt when information is established. } PPEalS are influential Mionale appeal, emotional Joy/fun appeal Reinforcem for repetiti eto gainor achieve for motivation, ¢g I appeal, threst/fear appeal ents is sed Wve types of behaviors Community-based Srl be established to reinforce Social pressure: Social Situations betes eM & Person in need of diet control for his diabet is Teo willing to adopt is encouraged by his family and friends, : on tain behavior change Need to be used with Tesources/mechanisms Pressure plays a role in various GUIDING PRINCIPL| BEHAVIOR ES IN PLANNING HAN: ACTIVity IGE COMMUNICATIONS Peg a Be onl be integrated with program goals from the “suppor, an ssential element of disease prevention, care and support program, providing critical linkages to other Program components, ‘including policy initiatives. * Continuous BCC assessment using formative methods Wr id us understand needs of target populations, any barriers to behavior change faced by the members (along with other populations, such as stakeholders, service roviders and community), ° The target population should participate in all phases of BCC development and in much of implementation. Stakcholders need to be involved from the design stage. ‘* Having a variety of linked communication channels is ‘more effective than relying on one specific one. * Pre-testing is essential for developing effective BCC materials. * Planning for monitoring and evaluation should be part of the design of any BCC program. . BCC strategies should be positive and action-oriented. STEPS OF BEHAVIOR CHANGE COMMUNICATIONS State Program Goals ‘This is the first step. The overall program goals are identified. After the thorough review, specific program goals are established using available data, epidemiological information and in-depth program situation assessments. Ive Stakeholders wolves the most important stakeholders prior to of the program and in every step of the program developmen’ ‘Stakeholders include policymakers, leaders, community leaders, religious leaders and opulations, Identify Target Populations \d define the target populations precisely Itis vital to identify populations are defined as primary or secondary. Primary populations are the main groups whose behavior the program is intended to influence. Secondary populations are the groups that influence the ability of the primary population to adopt or maintain appropriate behaviors. Conduct Formative BCC Assessments A formative BCC assessment looks out for: all studies that are available, data from in-depth assessments or rapid ethno- graphic assessments, behavioral surveillance surveys and other related studies. A formative BCC assessment protocol will be developed after compiling the information, ‘The formative BCC assessment should collectinformation © Risk situations, showing in detail how decisions are ‘made in different situations, including what influences the decisions and settings for risk and why individuals and groups practice the behavior they do, and why they ‘ight be motivated to change (or unable to change) to the desired behaviors. People's perceptions of risk and risk behaviors Influences on behavior, such as barriers or benefits Views of opinion leaders Patterns of service utilization and the opinions about these services Perceptions of social stigma and discrimination Future hopes, fears and goals Media and entertainment habits Health seeking behaviors Media resources Segment Target Populations Segmenting divides and organizes populations into smaller groups or audiences with similar communication-related needs, preferences, and characteristics. Taking inputs from formative BCC assessment, target populations are segmented based on their psychosocial and demographic characteristics, Comprehensive Textbook of Community Health Nursing fog (oF Be Define Behavior Change Objecy, ives One must precisely put down the objec This would help us know what behavios”®* Of Observable changes in behavior, ag roe change objectives, are a final program may include: ote * Knowledge change © Attitude change © Environmental change te led in, rome, fe SEES Formulate BCC Strategy Monit, Evaluation (Mande) Plan "Sang At the early phases of planning j evaluation plan” should have prepay “Motto Establishing effective information Collecting leg be in place to help in monitoring the include reports, site visits and reviews of so 2 tools and protocols must be a came consistency. Develop Materials/Message for Communication and Train Providers Create attractive and appealing theme to grab th, target populations. The theme should emer. formative assessment and consultation, "he Salient Features of the Theme The theme should be positive. It should not blame or stigmatize, * _ Itshould be appealing focusing on al target Steps in developing the overall theme and key © Create a profile of the target population from: BCC assessment. Identify desired behavior change. Understand and consider the different could affect implementation and decision-making. © Identify the information or data that you understood by the target population. atters. Choosing BCC assessment ce ‘ ple, television or radi ‘ dio spots i terial in brochures, px “ eS, posters, workers, peer educator S, counsellors, community events, ia onmed! 1 pretesting: All themes, messages, learning cond’ eraining PACKAReS, support tools and BOS ~ ascessment inventory must be pretested, Pre. fr ould evaluate Ie echenaioh ARtraction Persuasion ability « jndience members’ degree of identification jement and monitor: In this step everything gets into in? lion. There need to be good coordination among all Te pooprameci ad Shane strategy. It ts important to review the preceding steps to determine senether the rogram has covered the previously identified problems and needs ofthe target audience, 4» raluate: This step identifies to what extent project implementation attained its success in achieving predetermined objectives of behavior change, Some research designs widely used for evaluating the impact of heath communication program: Randomized control group design, non-equivalent control group desiga, one- gzoup-before after design, interrupted time series design, 4 Hlct feedback: Periodical needs of target populations are assessed to understand where they stand along the behavior change continuum. Monitoring and evaluation studies help in modifications of the overall program, This aso helps to modify the BCC strategies, messages and approaches. Behavioral change ey communication (SBCC) L (@ccy (7 Servser-receiver or expert to learner Fe-5.3: Evolution of social behavioral change communication communication Processes and strategies to address change at individual, | community and societal levels. Evolution of SBCC Information, education, ‘communication (IEC) + BCC — Bcc; ‘The SBCC has evolved from information, education and ‘communication (IEC) and health education (Fig. 5.3) Earlier, “expert-learner” or “sender-receiver” linear mod- ¢ls were in use to transfer information. The focus then shifted ‘o Behavioral Change Communication (BCC) which empha- sizes analysis of behaviors and determinants to affect changes in knowledge, attitudes and practices. Now, the focus is SBCC which executes a more comprehensive approach. SBCC—Five Key Facts about Human Behavior People Give Meaning to Information Based on the Context in which They Live For example, a person who witnessed deaths of COVID-19- affected neighbors may be more willing to take COVID-19 vaccine than the others may. Culture and Networks Influence People’s Behavior For example, treatment measures are highly influenced by religion, some religions do not accept surgery though surgery is ultimate measure to treat some conditions, People Cannot Always Control the Issues that Determine Behavior For example, woman needs husband’s support to space her pregnancies; if her husband disagrees, she cannot go for contraception. people's Decisions About Health and Well-Being Compete with other Priorities people often Make Decisions Based on Emotional Factors, Not Logic ample, despite knowing the health consequences of ed ancies, woman may tend to continue her vancies until she gets a male child, the priority. CHARACTERISTICS OF FRAMEWORK The SBCC has three distinct characteristics (Fig. 54). They are: 1. SBOCis a process SBOC uses a socioecological model ‘SBOC operates through three key strategies Five C-Planning Steps ‘The first characteristic says SBCC is a process. Hence, the ‘SBCC process runs in five steps: 1. Understanding the situation 2. Focusing and designing 3. Creating 4. Implementing and monitoring 5. Evaluating and Re-planning Introduction to Socioecological Model The socioecological model depicts the individual, and their «associations/relationships to people, organizations, and their Fig. 5.4: C-Planning book of Community Heath Nursing for Bge stages to thi Model Organizational, Commun Je y = ing behavior a, Mr intences, that 4 Ice Intapetet prychologeal) interpersonal (socal eugene ae ‘ommnunity, physical environmental, ang): "a f y Me Policy petlng models provide complete frameworks for CK interaction of multiple determinant oa Specifically, ecological models are help maa comprehensive intervention approaches th io target mechanisms of change at each leve| orn Application of Socioecological Moda, The Second Characteristic of SBCC Stat Socioecological Model SCY, ‘The SBCC uses a socioecological model that levels of influence to give us understanding on problems and find tipping points for change, Socgg 8 ‘Model for Change” is a combination of ecological ong sociological and psychological factors that will Pa engaged in analysis and planning. It has two part, te te ‘po 1, Levels of analysis: The concentric rings of, signifies both domains of influence as wel ay involved in each level. 2. Crosscutting factors in the triangle influence, actors and structures in the rings. = The levels of analysis (represented by the rings the individual most affected by the sue os) Direct influencers on the individual (represented ‘two rings): ‘ 1, The interpersonal: Partners, family, and pen 2. The community: Organizations, service sie tures, providers, as well as products aa ‘The interpersonal and community rings modify the nity and gender norms, access to and demand for resources, and existing services. Indirect influences make up the outer enabling est ment. These components may enable or impede change ™ legisaion, pli ach religion, technology, and government, business, faith and movement at whom advocacy and social mobilization Each level of analysis and the cach level are influenced by several erossutting triangle of influence). SBCC intervention foo 1, cross-cutting factors to generate change. bers either in isolation or in combination. To identi four large categories in which they found motivation, ability to act, and norms. as sf ru cross cutting factors Inomator knowledge Mowat atttiods, oer « Rity to actskits, se sits, stfcacy. access [Nore porch Soaocutural, gender Fig, in need of information that is timely ‘gent. SBCC practitioners assesses the level co pewon of group. For example, proving : = ost cervical cancer. Only some individuals, 4 communities may De empowered to act using the por most people, the provision of information meth enough 10 prompt change, ire motivation to act. People’s attitudes, of the benefits, risks, or seriousness of we tat programs ae tying tO change are the factors seroniae them, eg~ Peoples attitudes toward cervical SP rcesng; ble about the benefits of screening vr risk perceptions of cancer. SBCC strategies can ded these effective counseling, peer education, entertaining stiobadcasts, or TV programs. Effective communication teases can bring up changes in individual's attitude, fer andin social norms. fhe motivation may not be adequate to bring about age in behavior. Women in the countries of higher prelence rates of cervical cancer may present with some iubiltis Inability to spend for “Pap smear test” as well buy cndoms to protect from HPV), unprotected extramarital ssi ofthe partner, lack of water facies in low Spe in ey need ability to actin particular circumstances. frag ener assesses the actual skills, self-efficacy efficacy), and access of the actors. md and pert ae geet people rea! wa or perceptions cation Management and Health Education Socioecological model for change Skills This includes psychosocial life skills: problem-solving: decision-making; negotiation; critical and creative thinking: interpersonal communication; and other relationship skills, such as empathy. Self-Efficacy It is concerned with the confidence of individuals and groups (collective efficacy) in their own skills to affect change. Access This includes financial, geographical, or transport issues that affect access to services and ability to buy products. Norms ‘The perceived, sociocultural or gender norms have considerable influence. Norms reflect the values of the group and society and social expectations about behavior. © Perceived norms are those that an individual believes others are holding and therefore are expected of him or her. «Sociocultural norms re those norms that the community ae a whole fllows because of social status or cultural conventions. Gender norms determines the social views of expected behaviors of males and females. to address made concentrating ent understanding of the situation provides «Conducting @ program effectively on different groups of people including those affected and those influencing the «Addressing the problem identified and its context dicing corresponding SBCC strategies (advocacy, social silization, and/or behavior change communication.) Working with partners allies, and/or gatekeepers Four tasks should be completed before designing SBCC program. This will provide opportunity to under- stand the situation: 1. Organize and summ: about the situation. ‘Check assumptions by looking at existing research. Review relevant SBC theories for concepts that can inform and/or guide research. 4, Identify gaps and plan and conduct formative research, if needed. warize what is already known 2 3 Layers of Causes and Effects Problem Tree Information, knowledge, and motivational issues fall under dinect causes” on the left, while ability to act and skills-related issues goin the section by the same name on the right. A problem tree is a useful tool for SBCC practitioner for analyzing a situation. Use problem tree to document: © While planning for SBCC the practitioner think that he/ she knows about the situation and what he/she needs to {find out from evidence for the analysis to be complete. Problem Tree as a Tool Problem tree as a tool helps us to take a deeper look at causes, along with a comprehensive view of possible effects and ways to address situation most effectively (Fig. 5.6). * The trunk of the tree is used to depict the core problem. The roots and branches used to represent the basic or underlying causes of the problem, and the top of the tree shows the effects of the problem. Textbook of Community Health Nursing for ase Nursin ‘a LSZoN a Undertying causes Fig. 5.6: Problem tree © Crosscutting factors, depicted in the problem tree, serve as the bridge be brat Ievels, include: the = Direct causes, such as knowledg skills ° motivating, = Indirect causes, such as access to services mate, = Underlying causes, such as perceive norm actual social norms. People Analysis In the center (the self) are listed the people the problem. Examples might indude “Who are the people most affected | development an ‘hehe In the two intermediate rings (interpersonal and levels) are persons, community organizations, products that directly influence those most acid Examples might include: In the outermost ring (the enabling persons, groups, and/or institutions that indirectly people in the center (self) and all those in the Examples might include: Context Analysis © Community, services, and products: available community assets: services and are available, accessible and acceptable their quality. , © Enabling environment: Analy °° a political and religious conventions and sl port orimpede the change. Find *™ as.conmani Te gcan snot ramped the change Ase fo wi pecan enol and pata ge omit fe the formation recived abut the jon: Anliness, accessibility and relevancy «A peoples reaction, The need fo se ecoited ee for the motivating fctors that Aswract, attitudes and beliefs, appealing ' «eT oneeds, impact of gender norms on stay ther Ky information that cou hep sive them: somata assess their fe skills, strengths, resources, ani 076, services oF products, In addition, assess ssl ice on the ability 10 create change (self ini conP Te impact of gender norms to act, ceo) Wes the values gender norms, other , Norms, A norms, and thei feet on. peoples pon ide, el ably tact, and behaviors ino de ifuenceof values and norms on heath or seopment problem. arch findings Serve as sOUEES f0 efficiently deal sig a iscussed above. If the existing research does ae ee tnough information, formulate new research ct through conducting formative research, fon and answer overall Benefits of Understanding the situation «| Gaininsght into the issue the program is addressing from pany perspectives + omgnize and summarize what is known about the situation «Check assumpt dentfy gaps and plan for formative research Focus energies and resources and make decisions 4+ Focusa program effectively on different groups of people (those affected and those who influence them) + Addressa problem and its context through complementary SBCC strategies (BCC, community mobilization, and advocacy) sions by looking at existing research FOCUSING AND DESIGNING This isthe second step in planning. It provides direction and — products, materials, and activities all work together ; oo vision of change. A communication strategy ‘ument that helps the program to focus on: * Specific audiences Des signing activities, materials and products tion Management and Health Education High Wield Potential comn els for ication strategies and chi communicating information for a specific purpose Strategy for feedback mechanisms Commu nication strategies are developed after conducting ® Stvation ents developed after conducting Key Definitions * Segmenting divides and organizes populations into smaller groups or audiences with similar communication- 4. ite needs, preferences, and characterises rioritizing helps us determine what audiences We should focus on. * Profiling or describing allows us to imagine what the audience looks like and what their communication needs could be by personalizing audience members. Segmenting Audience ‘Audience can be divided based on: Enabling Environment Geographic or structural differences (e.g, urban/rural, risk settings, work place or residence). Community Demographic and sociocultural differences (e.g.. age, gender education, income, marital status, role in society, religion, ethnicity). Interpersonal Psychosocial differences (e.g., identity, lifestyle, group mem- bership). a: Self Psychological differences (e.g, knowledge/information, moti- vation, perceptions of vulnerability, readiness for change, values, attitudes). Setting Communication Objectives ‘Communication objectives are the ways to address barriers in order to achieve desired changes in policies, social norms, or behavioral determinants: © Specific policies, services, social norms, and/or behaviors for each audience. ‘© Information, motivation, ability to act, program should address. what the program wants the intended audience ities and and norms the © Exactly to know, feel, or do after being exposed to acti materials. k] Prggitals SBC jeveloped ‘creating 1 messages ¢ imury Necessary materi 4 Monitoring Implementing 2 ant fers slans into action. continuously asures « progeal isdone & © Im mis activities. rien one one co mmeck at both process (SCOP of activities) and © Keeps trac outputs (rest Assesses for im achievement of plannt its of activities). plementation of activiti ed activities. jes and the extent g and Replanning valu at dis ievesigu: a pm wveness in bri desired change. Evaluation compares variables and meas aeareever time. It also assesses for the CUTER level of the ‘measurable changes d and attainment es both Evaluatin: tation is data collection ogram’s effect crete points in time to ging about the sures barriers, that occurre of communication objectives. . er eome (short-term results) and impact (long-term effects). KEY STRATEGIES OF SOCIAL BEHAVIORAL CHANGE COMMUNICATION ‘The third characteristic feature of SBCC is, SBCC operates through three key strategies. They are as follows: Advocacy Advocacy to raise resources as well as political and social leadership commitment to development actions and goals. ‘Advowacy functions at the politcal, social and individual levels. Advocacy helps to mobilize resources, political and social commitment for social change or policy change. Resources refer to political wll, leadership, and money to fund the implementation of policies or programs. Advocacy targets tomake an enabling environment at any level, (ie. community level- traditional government. In addition, seeks for greater resources, encourage allocating the resources equitably, and remove barriers to policy implementation. Advocacy uses ASK APPROACH means Activate Leaders Share Action, Know the Context Social Mobilization Social mobilization for wider participatic . participation, coalition build- tp al onadiy adage Textbook of Com door outreac mobili members mein ston and evn the cue Pah « Q solutions. Behavior Behavior using mass interperson attitudes, an tunication strategies and appropriate group ja ‘The adv commitment; the tational level the community and alliances, The inn, focuses ens he community © PrOMP indiigal a munity actior met amunity Health Nursing for ase un nobilization Is a proces 88 that uses a variety of comme ity “y Ne ‘te "a stig -d those actions. jobilization activities exay WAY public meetings, health fan? sion efforts are community driven, qi ore active participants in definig. ing Change Communication n cnange common (BCC) ‘and social media, community | cae practices among specific audience, 3} “The above figure explains the behavioral omy jocacy in outer circle focuses on pol social mobilization in the sala ‘son individual and community. ing Principles in Planning SBCC Ag, Follow a systematic approach (e.,, C-P Use research, not assumptions to drive your pogay Consider the social context. Keep the focus on your audience(s) Use theories and models to guide decision eg socioecological model). ig « Communicati TERS! na _ gartners and communities throughout 5 seri esinfrcing materials and activites at man use ive roost ate ented e sare qual jes that are motivational and action "quality at every step. pasate Ques TO COLLECT SOCIAL reco FROMCLIENT rated from primary or secondary fatp us know the behaviors need to be changed, key ces Retjdivers and concerns related to consumption and gesrel ‘pehavior(s)- primary Data Sources we conduct among current/potential consumers eas prmary data sources: ene’ ‘quantitative: Methods ace-to-faceinterview/communication pline interviews using questionnaires ‘qualitative Methods Focus group discussions (FGDs): Conduct focus group discussions on the health problem with a few ‘groups consisting 6-12 members chosen from potential ‘audiences for 1 or 2 hours. Get their perspectives on the problem, including possible causes and contributors. Find cout the groups sources of information and influence as ‘well as their levels of knowledge, beliefs, and attitudes. © Individual interviews (IDI: Conduct informal interview for potential audiences. Visit with both those currently affected and those at risk. Ask them about their perspectives on the health problem. Interview both those who are already practicing behaviors that promote health and those who are not. * Site visits/observations: Visit places that are related to provision of health supplies and services. Observe how easy or difficult it is for clients to access a provider. Observe several client/provider interactions, allowing that your presence will change the interaction somewhat. Observe the conditions within which they are exchanging information, Make notes about your observations. * Interviews with stakeholders: Many “stakeholder y techniques” can be used to collect information. For jon Management and Health Educati Add ow o feu example: talk with program managers, community health workers (CHWs), clinic staff, and community leaders about the situation, Gather information from those who have an interest in control over addressing the problem. Ask them share insights on causes and contributors to the Problem, Find out what they are doing, how to address the Problem, and why. Ask those people help in identifying key strategic communication issues. Gender Analysis Gender analysis helps understanding how the gender differences affect access to resources and the participation of women in development activities. Local Level information Gathering and Planning This technique focuses mainly on local people to collect information such as perception on health, their lives with the health issues and views to change them. Two methods predominate: Use focus Group Discussions and interviews with potential audience members. These two methods are already discussed previously in this unit. Secondary Data Sources ‘These are readily available research data. We can elicit several kinds of information through such sources. To collect quantitative and qualitative studies and reports pertaining to health and communication, contact the ‘government departments (e.g,, public health, IT wing, national registries, etc.) Review the literature for unpublished documents, including internal reports that cover the subjects of interest: Literature reviews, population-based surveys, focus-group discussion reports, evaluation reports of other health programs, analyses of health care and health delivery systems, household surveys of knowledge, attitudes, and practices Inventories of communication, etc. Factors that Influence the Choice of Communication Channels © Complexity of the issue: Interpersonal communication (IPC) isthe most appropriateand effective communication for many situations. Nevertheless, it demands more time, ‘work and cost. Sensitivity of the issue: Mass media is not suitable to deal sensitive issues. Literacy: Print materials with extensive text not appropri- ate with low literacy levels. ® Comprehensive Textbook of Community Health Nursing for Pr BSC Nun 'e Desired reach: Mass media is appropriate when programs — Step 2: Select the Pr 7 siming at national or regional coverage ‘ rlority Audience . 1 effective SBCC strategy at airing sexual education related messages, ¢g..condom audience, but isthe group of people mn "2Y8 the messages , . in order to improve the health situatign,o°!™ior pi «Media habits and preferences of intended audiences: audiences may be atlon. Ror exe? Formative research is helpful eliciting answers to the MB ideetify the pitty au amp, questions related to access, habits, ete vision and health or social problem, Th i © Cost: The cost varies from place to place and this , who is most affected Hen conse, determines the strategy. (McKee, Bertrand, and Becker 4 How many p it jow many people are in the Benton 2004), audiences © How important it is that the aug behavior. dienes oy SBCC-STEPS IN INTERPERSONAL mae Hia a liRetys (aint tie: ana 1 audiences COMMUNICATION behavior. "8 will ch © Who controls the behavior or th the res behavior change. TOUT te Audience Analysis An andience analysis is a process used to identify and cunderstand the priority and influencing audiences for a SBCC Step 3: Identify Priority Audience Characte, strategy. The priority and influencing are those people whose Identify the sociodemographic, geogra behavior must change in order to improve the health situation. Beogtaphic and pay, characteristics of each priority audience (1a? their communication preferences and Ale! 51) ‘A complete audience analysis looks at: Sociodemographic characteristics such as sex, age, Teach them. * Opp language and religion. The above table gives an idea abou «Geographic characteristics, like where the audience lives sociodemographic, geogrephic, perchographic a and how that might impact behavior. their sources. In addition, i also provides the channeland other opportunitiesto elicitorcollers Psychographic characteristics are the attributes that [eT describe personality, attitudes, beliefs, values, emotions es ass Table 5.2 will help to know oy and opinions. Psychographic characteristics or factors mation under different heads relate tothe psychology or behavior ofthe audience. gy tep 4: Identify Knowledge, Atti «Audience thoughts, beliefs, knowledge and current actions 4 ws ge, Attitudes and sdesdas thea saa Find out what the priority audience knows, thins does about the problem in order to determine tne Barriers (emotional, societal, structural, educational, : familial, etc) and facilitators that prevent or encourage “U8 ‘of behavior change. This helps to form m audience members to adopt the desired behavior change. resis tae conithe audience's knowledge, ble © Gender refers to the socially and culturally constructed en ae st fcr nd roles and responsibilities deemed appropriate for MeN yehayior and should be considered ae — and women, how it affects audience members behavior ence’s knowledge, attitudes, beliefs and tial peers shows some of the ideational factors. © Effective communication channels for reaching the meen Step 5: Identify Barriers and Facilitators Step 1: Identify Potential Audience(s) Its vital to know what prevents or «xcoun audience to practice the desired behavior a " To address the problem brainstorm and list all potential and facilitators of change by walking th see ein ce abo Pe ee ay wants ord or social problem. For example, ifthe problem i high unmet _ conduct qualitative esearch (interew® 8 need for family planning, potential audiences may be: men, members ofthe priority audience. So™<" women, policy makers and heath care workers. Ahasrrincade A cation Management and Heath Education top Qt iets p raphic, 920072916 PSYCHOGPAPIC Factors and ther source, ; ts vers Beene Frequent vs where ater r coe a occasional use spend time rt el mm uae Usefor general + Activities neon ita eh information already participat ye co ened Use for health in o + Aetivites suis? See information Examples: vey = Census data * Attitudes and Examples Community events wel lll * Community media * Health line sth are a ee * Print Religious institutions na ne Sou tsonalty traits + Ratio Health fairs oo “hed Television * Schools and schoo! on * Market research = Mobile phone events wt * Consumer surveys * Social media - * Mediareports Sources i * Project esearch * Media reports me Pe ae eins Preferred medi unit pO i characteristics a a Radio © Sunday market Mobile phone * Temple | Community | Media | © Habit: People are comfortable doing things the same way they have always done them. © Fear: People expect change to bring negative consequences. Negative experience: Some audiences may have had a bad experience, such as with the health care system, and thus may be resistant to change. If the desired behavior requires utilizing products or services, one must assess for availabilty, accessibility, affordability and acceptability Step 6: Consider Audience Segmentation Dividing the priority audience into sub groups at least one similar characteristic that will the SBC effort. Identify the key Fig. 5.8: Ideational factors i a Plhiggital 1. “Step 8: Organize Influencing Audience Information (Table 5.3) Table 5.3: Organizing the influencers ‘Who influence the Degree of Cn priority audience? Wwfluence (strong, they currently peewee EL Comprehensive Textbook of Community Health Nursing for ge. Nur Sing Why would they peers PS Why would they ret ams eee eee eee ane RD Have many children Have a son Have a child immediately after marriage mother-in-law ery strong Step 9: Develop Audience Profiles Review the collected information about each audience and try to tell the story of that person. Audience profiles bring audience segments to life by telling the story of an imagined individual from the audience (Fig. 5.9). What are his goals? ‘© Has he been able to save money? © Where does he go in his spare time? What does he do there? © Why does not he practice desired behavior? © What are his biggest worries of life? How does he deal with them? = What are his goals? + Has he been able fo save money? Goris. emcney + Where does he go in his spare time? sea seus what does he do there? = Why does not he practice desired behavior? = What are his biggest worries of life? how does he deals with them? + What do his friends and family think or feel i“ or do that might make it easier for him to Jenoe ioe hjes|| practice the new behavior? + How do traditional gender roles influence his ite? + What gender issues have major impact on his behavior related to issue of concern? ——— * What does he do for a living? + Who ate his best friends? Job, frends, * What is his marital status? How many marialstatus, || children he has? children, home, || * What does he thin, fee! or do that might, neighbors me momar practice the new behavior? 7 ‘of home he lives in? who. live with him? eee L____| [Who are his neighbor? a ay Fie 53: suena nie The motherin-law | * ceares the health of the baby Traditionally the number of children in family shows the status of that family in community, Having a child immediately after marriage shows na "er What do his friends and family think gg might make teaser forhim to practise How do traditional gender roles influengs isi © What gender issues have major i rosie @ une ofemacernt? a © What does he do for a living? © Who are his best friends? ® What is his marital status How maty cies * What does he think, fee! or do that might nae practice the new behavior? © What sort of home he lives in? Who ese ei . Who are his neighbors? INTERPERSONAL COMMUNICATION In the context of social and behavior change communi (SBC), interpersonal communication is most uff educators, community health workers, counselosinad or community setting, during community discus when doing personal advocacy with influential peop health issue. ‘There are five steps in IPC: a Suitable rity Audience 1, Decide Whether IP\ Intervention for the P: The decision of using IPC depends: (1) the of the audience and (2) the type of intervention address behavioral determinants of healt i analysis would help us know what media? exposed to, their key influencers, and thet P® of health information and opinion. anagement and Health Education suction Ne eee Liveeipert ret ala Pcographi, + Frends/peer ° Fay toca communi ica community adonsland + Community health worker * Facility-based provider 7 + Telewlon + Radio ; > rin * Social media 7 * Mobile phone © Internet i men eae 2. The tools (supporting materials to guid Perceived lack of social support to #3"t ‘or maintain behavior In-depth information on a di concept Confidential or sensitive concept Discussion of myths and misperceptions Discussion of a health behavior between two involved parties Demonstration of method use ficult private discussion of le the counselor! jethod when: oitable me - a " 8 priority sudience) ‘preferred information source” facilitator in method and content). fe ne ofthe Bt Four liste inthe table belowe 3. The cation or setting where the IPC takes place. pad one of the «information needs” listed in the third a) Using the above table as a guide, fill out each column, of the ela “Tools Template (see Template 5.1: IPC Methods and Tools). gewhich IPC Method to Use and “The next step is to look at whether the IPC agents have e peci : requisite skils and tools they need to effectively execute the eet Supportive Tools Needed ee senipiog cas potent effective intervention to say auinces coos te eae kad ihat wil 3-Assess and Build Counseling and ait forthe program” (Table 5.5). There are three aspects sptbe IPC approach: F re human component (interpersonal skills of the IPC agent ess rprsona communication method Tools to support IPC fn Madience information needs Counseling guide in-depth information on ‘One-on-one counseling session between client and clinic health dificult concert BF edenialorermane | worker, CANTLEE health Videos er cla snctive | worker, counselor (Pao or | + Wall posters Through hotline/helpline), peer | * Peer education guide concept. | trsaion otsayths of | educator communication OF ec misperceptions Discussion ofa health behavior between two involved parties agent Interspousal, parent-child, oF teacher-student discussion Facilitated support group Discussion guide dressing perceived lack ofsocial support to start or discussions rmirtain health behavior Demonstration of method use | Demonstration of skills + Video or print teaching aid ‘nd modeling how to discuss = Materials for ea demonstration «Role play to demonstrate discussion and negot Informational flip chart Discussion guide with tips for navigating the conversation tiation > Family planning counseling kit and flip chart | Counseling euide for HIV. | hotline onreereainans manual | + ART disclosure guide (parent-child). | + Discussion guide for newly ‘married couples PLWHA support group discussion guide © How to put on a condom correctly = How to mix ORS = How to wash hands correctly 231) Some of the key as * Non-judgmental openness: Putting aside one’s own value judgments and being open to see the issue from the audience’ point of view * Listening actively to what the client/individual/group has * Summarizing what has been heard * Paraphrasing what has been heard to confirm it has been od correctly flecting on what has been said and what can be done as positive action going forward Praise, encouragement and reassurance to help clients practice or continue to practice the positive health behavior Referral services and products that the client will require to practice the health behavior. 4, Assess and Plan Development of Effective IPC Tools Counselors and facilitators need the help of good quality 1PC tools to be most effective. These tools may be adapted or created. The existing tools can be checked for relevancy. Effective IPC tools should include the following elements: ‘A lear focus on the identified primary audience Well-articulated objectives of what will be achieved by using this tool ‘A reminder of basic communication and facilitation skills Scripts, facilitation guide and talking points where helpful and relevant Correct and consistent information about the health . jesue/behaviors that are consistent with program and national strategy © Glossary of key words, health/technical terms and phrases with translation into the local language for ease of reference for counselor and facilitator ‘© List of frequently asked questions about the topic and their answers © List of additional resources for further reference on the topic. In addition, © Short, informational videos © Attractive visuals—Posters or flip charts with simple information Take-home materials to reinforce key information Models or props to help with demonstrations. 5. Develop IPC Intervention After completing the above steps, assess: . Whether IPC suits for activity er OS iy IPC method best suity supporting tools required” "Me aug, * The skill level of the course, i those skills, fnecessary —”* 8M ste ‘ . oy The availability of existing tool, 3 of new tools is necessary. * Whethep After going through all the aber be started Te SEPS the ity BARRIERS TO EFFECTive COMMUNICATION At Individual Level A number of factors affect individual bg make it either easy or difficult to ct ability and willingness to adopt change behaviors. Knowledge or awareness, service are seldom the only reasons adopting positive behaviors. Individysy, "ie reasons for adopting or resisting betsy!" Hine barriers or facilitators referred to “behayign term f ind mai in 2 heh Individual Barriers © Habit: People are comfortable doin, things 4 theyhave always done them, '"Sthe © Fear: People expect change to brin sequences. 'S Nepating © Negative experience: Some audiences bad experience, such as with the healiy thus may be resistant to change © Lack of awareness of the service ang) health benefit. * Lack of awareness ofthe skill oF steps rested the service. © Beliefs about the required skills orbehsviow Ti be too difficult. He or she may not have time the skill. May not be able to perform alone hag cate 5, or the Example: In COVID-19 outbreak- Individuals | desired behaviors, they should know the risk of protective measures and they need to feel that thy risk for transmission; and they need the skills to protective behaviors. mmunication Management and He con ‘on the individual while adc ors. This may be the one of the «influences from the situational context in i lives and in that social relationships ar dividual eristics of the context are associated with sctors and include leadership, access to provision, social capital and collective wa i nple: individuals pont 7, if leaders P* jena ir importance and are more likely to practice desired romote them, the whole community oe if proper information and peers port ae pec norms mano in community oF organization has power ules participate ip decisions for the group. For example, in aia mmnunitieS> ‘only married adult men or elder women oa mi make decisions about ‘community and health ailbles eee so dictate whether a female client or ese norms may al 3 i bg

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