A Learning Package For Social and Behavior Change Communication
A Learning Package For Social and Behavior Change Communication
This publication is made possible by the generous support of the American people through the United States Agency for International
Development (USAID) under the terms of Agreement No. GPO‐A‐00‐07‐00004‐00. The contents are the responsibility of the C‐Change project,
managed by FHI 360, and do not necessarily reflect the views of USAID or the United States Government.
The six modules can be freely adapted and used, provided full credit is given to C‐Change. Recommended citation:
C‐Change. 2012. CModules: A Learning Package for Social and Behavior Change Communication (SBCC). Washington, DC: C‐Change/FHI 360.
C‐Change is implemented by FHI 360 and
its partners: CARE; Internews; Ohio
University; IDEO; Center for Media
Studies, India; New Concept, India; Soul
City, South Africa; Social Surveys, South
Africa; and Straight Talk, Uganda.
Contact information:
C‐Change
FHI 360
1825 Connecticut Ave., NW, Ste. 800
Washington, D.C., 20009
USA
tel: +1.202.884.8000; fax: +1.202.464.3799
Email: [email protected]
Website: www.c‐changeproject.org
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Why use
Answers to key questions
theories and
models?
What
Wh t problems
bl exists
i t Evolution of Key Concepts
Why a problem exists
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Transmission
Sender Receiver
Photo credit: Narendra Basnet. “Pretesting Communication Materials with Special Emphasis on Child Health and Nutrition Education: A manual for Trainers and
Supervisors.” UNICEF, Rangoon. Adapted from: Douglas Storey—JHU, Center for Communication Programs
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Communicator
Older
Old approaches
h ttried
i d tto persuade
d iindividuals
di id l tto
Communicator
change their health behaviors
Newer approaches try to create an enabling
environment to encourage healthy behaviors
New approaches look for tipping points of change
that need to address social change as much as
individual behavior change
Adapted from: Douglas Storey—JHU, Center for Communication Programs Adapted from: Douglas Storey—JHU, Center for Communication Programs
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Emphasis of some core theories Individual level: Health Belief Model (1950s)
Th
Theory E h i
Emphasis More
M People form behaviors based on perceptions:
Individual level individual 1. How severe is the illness?
1. Health Belief Model Planned behavior, rational 2. How likely could I get it?
decision making processes
3. What do I benefit from trying to prevent it and how
2. Reasoned Action – Fishbein & Ajzen
3. Stages of Change – Prochaska, (beliefs & subjective norms)
DiClemente effective is the new behavior?
Fear Management – Witte Interaction between cognition 4. What keeps me from taking this action?
& emotion
Interpersonal level
Social learning – Bandura Social comparison, learning Application:
from role models, self efficacy
Address personal risk perception and beliefs in severity of
Community level disease
Theory of Gender and Power Social influence, personal Identify
Id tif k key b
benefits
fit and
dbbarriers
i tto change
h and
d stimulate
ti l t
Diffusion of Innovations - Rogers networks
discussion
Ecological Models Behavior is a function of the
person and its environment
More Demonstrate potential positive results of change
social
Adapted from Douglas Storey—JHU, Center for Communication Programs
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Individual level : Reasoned Action (1960s) Individual level: Stages of Change (1980s)
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Individual level: Fear Management Theory Interpersonal level: Principles of Social Learning (1970s)
Source: Kim Witte (2004) summarized by Douglas Storey—JHU, Center for Communication Programs
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A person’s
’ bbelief
li f iin th
their
i ability
bilit tto achieve
hi a desired
d i d List of eight conditions represented in all theories:
One or more of these conditions must be true for a person to perform a
outcome
given behavior: The person
Self-efficacy is perceived regardless of one's actual 1. Has formed a strong positive intention to act
ability. 2. Has no environmental constraints for the behavior to occur
3
3. Has needed skills to perform the behavior
If a person sees someone else performing a behavior 4. Believes the advantages/benefits outweigh disadvantages of performing the
behavior
but doubt their own ability to copy it, its not likely 5. Perceives more social pressure to perform than not to perform the behavior
that the new behavior will be adopted. 6. Perceives that behavior is consistent with self-image and personal standards
7. Reacts emotionally more positively than negatively to performing the behavior
8
8. Believes that they can execute the behavior (self
(self-efficacy)
efficacy)
Source: Adapted from Albert Bandura, Psychology Review 1977, Vol. 84, No. 2, 191-215. See also his Self-Efficacy: The Exercise of Control (New York: W.H. Source: Fishbein, M et al. 1991: Factors Influencing Behaviour and Behaviour Change. Final report prepared for NIMH Theorists
Freeman and Company, 997). Workshop, Washington, DC
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Psychological
P h l i l and d psychosocial
h i l th
theories
i were very People make decisions based on:
Wider social and environmental issues surrounding women such
useful early in the HIV epidemic to identify as
individual transmission behaviors. Distribution of power and authority
Gender specific norms outside of and within relationships
But
Application:
….nearly all the individually based theories were
Assess impact of structural gender differences and social norms
developed in the West with little focus on the role of on interpersonal sexual relationships
gender and culture. Investigate how a woman’s commitment to a relationship and
lack of power can influence her risk reduction choices
Source: UNAIDS 1999: Sexual Behavioural Change for HIV: Where have theories taken us?
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I
Innovations
ti are spread
d th
through:
h A shift in thinking
Social networks over time
The speed at which an innovation spreads depends on
What people think about the innovations and the people using it
SOCIAL AND BEHAVIOR CHANGE
How well the social network works
COMMUNICATION
Application:
Identify how audience thinks of the innovation
Identify opinion leader in the network
Identify
y messages
g that address concerns about the innovation
Demonstrate what happens to others when they try the
innovation
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SBCC iis th
the systematic
t ti application
li ti off iinteractive,
t ti th theory 1. SBCC isi an interactive,
i t ti researched
h d and
d planned
l d
based, and research-driven communication processes and process
strategies to address “tipping points” for change at the
2. SBCC requires a socio-ecological model for analysis
individual, community, and social levels.
to find the tipping point for change
A tipping
pp g ppoint refers to the dynamics
y of social change
g
where trends rapidly evolve into permanent changes. 3. SBCC operates through three main strategies,
A tipping point can be driven by a naturally occurring event or a strong namely
determinant for change, such as political will, that provides the final a) advocacy,
push to “tip over” barriers to change.
b) social mobilization, and
Tipping points describe how momentum builds up to a point where
change gains strength and becomes unstoppable. c)) behavior change communication
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Characteristic 3: SBCC Operates Through An ecological SBCC approach needs a broader theory base
Analysis determines
the mix of strategies. Three Key Strategies
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Effectiveness of Effect of
communication
Communication
Estimated Median cost per
on behavior Intervention category iinfections
f i averted
d person reached
h d
($)
Stover & Bollinger (2004) Condom distribution 261,798 0.15
Analyzed types of HIV/AIDS
interventions to estimate VCT 102,572 50.00
number of infections averted
(USAID target: 7 million Mass Media 66,770 0.42
averted)
Blood Safety 35,147 5.20
Source: Summarized by Douglas Storey—JHU, Center for Communication Programs from Stover, J. & Bollinger L, 2004. Infections averted by year one
activities as described in the country operational plans of the PEPFAR (manuscript)
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Source: Snyder L., Diop-Sidibé N., Badiane L. A Meta-Analysis of the Effectiveness of Family Planning Campaigns in Developing Countries. Presented at
Source: Arzum Ciologlu, JHU-CCP, ppt with C-Change, URC on SBCC as High Impact Practice for USAID the International Communication Association Meeting, May 2003
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Conclusion
1 Th
1. Theories
i are tools
t l for
f creative
ti thinking,
thi ki nott absolute
b l t truth
t th
or formulas for success
2. Use theories to check your assumptions
3. No one theory will explain every behavioral setting
4. The ecological SBCC model combines various theories
5. Creative and tailored use of models and theories increases
the success of interventions
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GLOSSARY ADDITIONAL RESOURCES
Glossary of Termsi
A
4A Model: used to facilitate four steps in client‐provider interaction: Ask, Advise, Assess, Assist, and Arrange for follow‐up.
Ability to act: a crosscutting factor. People need the ability to act in particular circumstances that pose a threat. Look at the actual skills, self‐efficacy, and of
the actors.
Access/accessibility: ability of an individual or group to use a service e.g. use of health care services. This is a concept from individual level theories in the
Graphic: Concepts of Selected SBCC Theories.
Activity: a specific event or action.
Advocacy: a continuous and adaptive process for gathering, organizing, and formulating information into an argument to be communicated through various
interpersonal and media channels with a view to raising resources or gaining political and social leadership acceptance and commitment for a development
program, thereby preparing a society for its acceptance.
Agenda dynamics: refers to the relation among media agenda (what is covered), public agenda (what people think about), and policy agenda (regulatory or
legislative actions on issues).
Agenda setting: a technique by the mass media to focus attention on issues, helping to generate public awareness and momentum. Research on agenda
setting has shown that the amount of media coverage of any given issue correlates strongly with public perception on its importance. This is a concept from
media theories in the Graphic: Concepts of Selected SBCC Theories.
Allies: institutions, associations, spokespeople who can serve as a resource, usually on a short‐term basis. Their support can be financial, technical, human,
or material.
Assetsbased approach: an approach to community development that seeks to draw on the community’s own strengths and resources for addressing
concerns.
Attitude: a cross‐cutting factor. Personal dispositions towards a particular subject or situation; how we generally feel about a situation. This is a concept
from the individual level theories in the Graphic: Concepts of Selected SBCC Theories
B
Barrier: a difficulty or obstacle that people face that can stop them performing desired behaviors to the problem you’ve identified.
Behavior change communication (BCC): is a researched‐based, consultative process of addressing knowledge, attitudes, and practices through
identifying, analyzing, and segmenting audiences and participants in programs and by providing them with relevant information and motivation through
well‐defined strategies, using an appropriate mix of interpersonal, group, and mass‐media channels including participatory methods.
Behavioral skills: the physical and psychosocial ability to behave in a particular way, e.g. negotiating use of condoms in sexual encounters.
Belief: a cross‐cutting factor. This is a concept from the individual level theories in the Graphic: Concepts of Selected SBCC Theories
Biomedical interventions: interventions in which the administration and use medicines are key features.
C
CPlanning: Characteristic 1 of C‐Change’s SBCC Framework. It is a five step interactive and researched process that includes understanding the situation,
focusing and designing, creating, implementing and monitoring, and evaluating and replanning. All the steps of C‐Planning draw on previous ones and
contribute to subsequent ones.
Campaign: goal‐oriented recognizable attempt to inform, persuade or motivate change within the intended audiences; linked series of activities with
mutually supportive messages.
Capacity strengthening: the process of increasing people’s skills and knowledge in a particular area that enable them to build and use their own strength to
solve problems. Capacity strengthening suggests that programs build on existing resources while capacity building suggests limited local capacity that needs
to be built from scratch.
Catalyst: a dynamic, iterative process that leads to dialogue within the community that when effective, leads to collective action and resolution of a common
problem. This is a concept from the community organization theories in the Graphic: Concepts of Selected SBCC Theories.
Channel: three categories of communication channels are interpersonal, community, and mass media. Interpersonal channels include one‐on‐one
communication such as hotlines and counseling. Community channels reach a group of people within a distinct geographic area or reach a group that shares
common interests or characteristics. Community‐based media, community‐based activities, and community mobilization are all examples of community
channels. Mass media channels, which can reach large audiences quickly, can include television, radio, newspapers, magazines, outdoor/transit advertising,
direct mail and social media.
Channel mix: the use of at least two or more different media in one communication campaign with the goal to increase intensity, reach, and frequency of its
content to reach intended audiences. The three channels are interpersonal, community based, and mass media.
Choice architecture: the act of “nudging” people toward more healthful or socially beneficial behavior by designing available choices in such a way that
individuals will be steered toward the “right” choice.
Cohort: a group of people sharing a common characteristic, e.g. females born in 1985, males who have never has sex, etc.
Collective action: social movements by citizens to promote social change in policies, laws, social norms, and values. This is a concept from social movement
and community organization theories in the Graphic: Concepts of Selected SBCC Theories.
Collective norms: norms that operate at the level of the social system (social network, community, entire society) and represent a collective code of
conduct.
Communication objective: name SMART ways to address barriers to achieve desired change in policies, social norms, or behaviors. They are audience‐
specific and contribute to program objectives (see program objective definition).
Communication strategy: a comprehensive document that guides and links decisions on intended audiences, communication objectives, channels and
materials based on analysis and integrated by a strategic approach.
Communitybased social marketing (CBSM): relies on formative research conducted in the community to ensure that existing and perceived benefits and
barriers are understood prior to the design of an intervention/campaign/activity. It involves the promotion of both actions and/or products. This is a
concept from social marketing approaches in the Graphic: Concepts of Selected SBCC Theories
Community empowerment: process by which communities are enabled to assume leadership and exercise control over the processes and resources for
their own transformation.
Community mobilization: a capacity‐strengthening process through which community individuals, groups, or organizations plan, carry out, and evaluate
activities on a participatory and sustained basis to improve their health and other needs, either on their own initiative or stimulated by others.
Community participation: process through which communities participate in determining their condition without necessarily controlling the process.
Community: a group united around a shared characteristic or concern or a group of people located in the same area.
Concept testing: a type of formative evaluation that involves systematically gathering intended audience reactions to creative concepts and “big ideas” that
capture the essence of what you want to communicate to your intended audience before finalizing concepts and formats for pre‐testing.
Contemplation: used in the stages of change theory to describe the period prior to adoption of a new behavior when one is thinking but not yet acting.
Creative brief: is a short tool to guide the development of materials and activities.
Critical mass: in order for social conventions to change, a “critical mass” of community members needs to agree to the change.
Crosscutting factors: are represented in the triangle of influence in the socio‐ecological model. These factors are put into four large categories:
information, motivation, ability to act, and norms which SBCC interventions may be able to modify to generate change.
Cues to action: part of the Health Belief Model and indicate an active readiness to change. This is a concept from individual level theories in the Graphic:
Concepts of Selected SBCC Theories.
Cultural relevance (or making meaning): the culture‐centered approach involves designing change interventions and activities that relate to a culture or
community’s framework or understanding. Local cultural systems are the basis for the development of meaning about specific social change issues. This is a
concept from culture theories in the Graphic: Concepts of Selected SBCC Theories
D
Determinant: factor that cause changes e.g.; in behavior.
Diffusion of innovation: process by which an innovation is spread in a given population over time. Under the right conditions, innovations (new services,
products, best practices) can be successfully introduced/communicated and adapted at the individual, community, and organizational level. This is a concept
from the network theories and a set theory of its own in the Graphic: Concepts of Selected SBCC Theories.
E
Ecological: in this context means the relationships between individuals and their environments.
Ecological perspective: Ecological in this context means the relationships between individuals and their environments.
Emergent change: change that is already occurring, whether it’s planned or unplanned.
Empowerment: refers to the process by which individuals and communities gain confidence and skills to make decisions over their lives. This is a concept
from the community organization theories in the Graphic: Concepts of Selected SBCC Theories.
Environment: the physical, emotional, or social contexts that shape community and individual attitudes and behaviors.
Epidemic: significantly high incidence of disease occurrence in a population.
Evaluation: a process that tries to determine as systematically and objectively as possible the worth or significance of an intervention. In this course, we
focus on evaluating the outcomes of your SBCC efforts.
F
Focus group discussion: in‐depth discussion in which a small group of people, usually 8 to 10, talk about a topic of common interest to all the participants.
These group discussions take place under the guidance of a facilitator and are used to collect research data or test materials.
Formative research: research conducted during the planning process that allows program planners to obtain insight into, e.g.; the knowledge, attitudes,
and practices of the situation. This research helps to form, plan and develop communication programs and determine audiences and strategies.
Framing: how issues are presented in news coverage. The same issue can be described in different ways depending on the narratives and sources used.
Experimental research shows that news frames strongly influence how people perceive issues and think about possible courses of action. This is a concept
from media theories in the Graphic: Concepts of Selected SBCC Theories.
G
Gatekeepers: powerful individuals or groups that influence the environment that can inhibit or promote change (open or close the “gate”). They can be
brought in as partners, or “neutralized” so as not to inhibit progress.
Gender: roles in societies that are considered appropriate and expected for men and women.
Gender analysis: methodologies for assessing the relative power of males and females in a given community.
Gender inequality: conditions under which men and women are systematically provided different access to resources for self determination such that one
accrues unearned advantages over the other.
Gender roles: behaviors expected of males and females on the basis of their sex, not their abilities.
Generalized epidemic: HIV is firmly established such that sexual networking in the general population is sufficient to sustain the epidemic independent of
sub‐populations at higher risk of infection.
Goal: General statement that describes the result hoped for of a program (e.g., reduction of HIV incidence). Goals are achieved over the long term and
through the combined efforts of multiple programs.
Group norm: established attitudes, patterns of thought and behaviors within a particular group.
H
Health literacy: an individual’s capacity to obtain, process and communicate information about health and is needed for patient self‐management (e.g.
health information seeking, coping with treatment effects, disease monitoring, navigating referrals, etc). This is a concept from the patient centered
communicational models in the Graphic: Concepts of Selected SBCC Theories.
I
Impact: long‐term effects (e.g., changes in health status). This can be through special studies with wide district, regional, or national coverage.
Incidence: the number of new cases of infection within a specified period of time.
Indicator: clue, sign, and marker that show how close we are to our path and how much things are changing. The clue “indicate” possible changes in the
situation that may lead to improved health status.
Informal communication: communication networks that fall outside of established systems for conveying information, e.g. information communicated
over drinks at the bar or by the communal pipe stand.
Information: a crosscutting factor. People need information that is timely, accessible, and relevant. When looking at information consider the level of
knowledge held by that person or group, e.g., about modern contraceptives and their side effects.
Information education communication (IEC): a communication strategy for influencing behavior which emphasizes information and education.
Input: resources going into conducting and carrying out the project or program. These could include staff, finance, materials, and time.
Institutional bias: official policy or established procedures that discriminate e.g. applications for loans are accepted from married males, but not married
females without the spouse’s consent.
Interpersonal communication: face to face exchange of e.g.; information, education, motivation, or counseling.
Intervention: a set of complementary program activities designed to achieve program goals.
Inventory review: a methodical search for existing materials and activities developed by other programs, It can help put resources to good use by
complementing or adapting rather than recreating what is already out there.
K
Knowledge: a cross‐cutting factor. What people know on a certain subject matter based on education or experience. This is a concept from the individual
level theories in the Graphic: Concepts of Selected SBCC Theories.
L
Learning: process of mastering or internalizing values, knowledge, skills through socialization, formal instruction, or experience.
Levels of analysis: are the rings of the socio‐ecological model and represent both domains of influence as well as people representing them at each level.
Logic model: a visual representation that charts (or maps) a path for the problem to be addressed, to the inputs (available resources), then outputs
(activities and participation) to finally arrive at outcomes (short, medium and long‐term results), which will ideally lead to impact (long‐lasting change).
M
Maintenance: having to do with the ability of an individual to continue with a newly adopted behavior.
Making meaning: see cultural relevance
Media advocacy: civic actions used to shape media attention on a specific issue. It’s how groups that promote social change persuade the media, through
various techniques, to cover the issue. This is a concept from media theories in the Graphic: Concepts of Selected SBCC Theories.
Message: a brief, value‐based statement aimed at an audience that captures a concept. Messages must be personally appealing and discuss only one/two
key points. The information in the message should be new, clear, accurate, and complete, culturally appropriate, and include specific suggestions of what
people can do.
Model: draws upon multiple theories to try to explain a given phenomenon.
Modeling: people learn not only from their own experiences but by observing others performing actions and the benefits that they gain through those
actions.
Monitoring: a process of tracking or measuring what is happening in programs. In this course we focus on monitoring two aspects of your SBCC activities:
process and quality.
Motivation: a crosscutting factor. Factors influencing individuals to attend to and act upon information and knowledge. People require motivation often
represented by attitudes, beliefs, or perceptions of benefit, risk or seriousness of the issues they are trying to change. This is a concept from the individual
level theories in the Graphic: Concepts of Selected SBCC Theories
N
Norms: reflect the values of the group and specify those actions that are expected of the individual by its surrounding society as expressed in perceived
norms, socio‐cultural, and gender norms have considerable influence.
O
Objective: specific, operationalized statement detailing the desired accomplishments (includes communication and program objectives). A properly stated
objective is action‐oriented, starts with the word “to,” and is followed by an action verb. Objectives address questions of “what”, “when,” and “how much”,
but not “why” or “how.” An objective is stated in terms of results to be achieved, not processes, or activities to be performed.
Observational learning (modeling): people learn not only from their own experiences, but by observing others performing actions and the benefits they
gain through those actions. This concept has been influential in developing entertainment education programs. This is a concept from the social learning
theories in the Graphic: Concepts of Selected SBCC Theories.
Outcome: short‐term or intermediate result and change in your population/community that are obtained by a program through the execution of activities.
Output: immediate result obtained by the program through the execution of activities (e.g., number of commodities distributed, number of staff trained,
number of people reached, or number of people served). Good process monitoring of outputs from activities (if mutually supportive) can lead to program
outcomes and hopefully have impact!
P
Participation: playing an active and meaningful role in decisions that affect one’s interest. This is a concept from the community organization theories in
the Graphic: Concepts of Selected SBCC Theories.
Partners: any group, formal or informal, with whom you might work long term to make your effort a success overall.
Patient preferences: Patients have varying expectations for their own role and that of the provider, often associated with socio‐demographic and cultural
characteristics.
Perceived barrier: belief or perception that there are negative consequences associated with a contemplated change. This is a concept from theories
highlighting perceptions in the Graphic: Concepts of Selected SBCC Theories.
Perceived benefits of action: the belief that there are benefits or positive outcomes associated with changing a current action or situation. This is a concept
from theories highlighting perceptions in the Graphic: Concepts of Selected SBCC Theories.
Perceived norms: norms that are the result of individuals interpreting and perceiving values, norms, and attitudes other around them hold. This is a
concept from individual level theories in the Graphic: Concepts of Selected SBCC Theories.
Perceived risk: belief or perception that one is likely to fall victim to a particular illness if prevailing conditions remain unchanged. This also referred to as
risk perception. This is a concept from theories highlighting perceptions in the Graphic: Concepts of Selected SBCC Theories.
Perceived vulnerability: recognition that current situation places one at risk of infection. This is a concept from theories highlighting perceptions in the
Graphic: Concepts of Selected SBCC Theories.
Persuasion: is a form of communication that seeks to influence attitudes or behaviors without the use of force or coercion. This is a concept from media
theories in the Graphic: Concepts of Selected SBCC Theories.
Policy/legislative change: change that social movements promote to advance their causes and build coalitions with allied policy‐makers.
Popular education: education that employs simple, learner‐centered methods and is aimed at broadening people’s understanding of factors which affect
their lives.
Positioning (in the context of strategic design): presenting an issue, service, or product so that it stands out from others, is appealing, and is persuasive.
Positioning creates a distinctive and attractive image which may be turned into a logo.
Positioning statement: describes how a proposed changed will be seen in the minds of the audience. It is not a catchy slogan, but rather provides direction
for message design.
Positive deviance: an approach that seeks to understand why a minority in a given community practices healthy behaviors, and integrates those insights
into effective planning.
Prevalence: the proportion of persons in a population who have a particular disease or condition.
Problem statement: succinct summary of what is discovered during the situation analysis that helps programmers clearly see what is happening so that
they can focus attention where it will make a difference.
Process: set of activities in which program resources are used to achieve the results expected from the program (e.g., number of workshops or number of
training sessions).
Program objective: the specific outcome that you expect your entire program to achieve. It is broader than a communication objective, but must also
specify an outcome.
Projectable change: change that can be planned and implemented.
Psychosocial and life skills: a set of skills including problem solving, decision‐making, negotiation, critical and creative thinking, interpersonal
communication and other relationship skills such as empathy. This is a concept from individual level theories in the Graphic: Concepts of Selected SBCC
Theories.
Q
Qualitative method: help build an in‐depth picture among a relatively small sample of people on a specific issue. They reveal in more detail how people
perceive their own situation and problems, why and what their priorities are. Questions are asked in an open‐ended way and the findings are usually
analyzed as data is collected. Information gathered should not be described in numerical terms, and generalization about the intended audience cannot be
made. It is a useful tool for exploring reactions and uncovering additional ideas, issues, or concerns.
Quantitative method: things are either measured or counted, or questions are asked according to a defined questionnaire so that the answers can be coded
and analyzed numerically by asking a large number of people identical (and predominantly close ended) questions. If the respondents are a representative
random sample, quantitative data can be used to draw conclusions about the intended audience as whole. Quantitative research is useful for measuring the
extent to which knowledge, attitudes, or behaviors are prevalent in an intended audience.
R
Rational choice: assumes that people are driven to maximize perceived individual beliefs.
Reinforcement: information, actions or ‘rewards’ which encourage adoption or continuation of a particular behavior.
Risk factor: conditions associated with increased likelihood of a particular disease or condition, e.g. individual behaviors, lifestyle, environmental exposure
or hereditary characteristics.
Risk: increased probability of being affected.
Risk group: a group of people sharing characteristics that put them at risk for and make them more likely to become infected than the general population.
Role model: someone who is respected and revered such that one patterns one’s behavior by following their example.
S
Segmenting: dividing and organizing an audience into smaller groups who have similar communication‐related needs, preferences, and characteristics.
Selfdetermination: refers to the capacity of individual and communities to make decisions without interference or influence from other actors.
Self–efficacy: the belief and confidence in one’s ability to do something successfully. This is a concept from individual level theories in the Graphic: Concepts
of Selected SBCC Theories.
Sequencing: the order in which activities are implemented.
Sex: biological and physiological characteristics that define what men’s and women’s body physically are able to do.
Situation analysis: a systematic review of social, cultural, political, and behavioral data aimed to identify internal and external determinants of a situation,
such as immediate and underlying cause and effects.
SMART (objectives): specific, measureable, attainable, realistic, time‐bound
Social and behavior change communication (SBCC) framework: lays out the three characteristics of SBCC that the C‐Modules and C‐Change use. It
requires an interactive, researched, and planned process; C‐Planning; a socio‐ecological model for analysis to find the tipping point for change; and operates
through three key strategies ‐‐advocacy, social mobilization, and behavior change communication.
Social capital: refers to the institutions, norms, and values of social networks and their impact on social relationships and institutional resources. The
theory argues that groups and societies with higher levels of social cohesion and trust are fundamental for societies. This is a concept from the network
theories in the Graphic: Concepts of Selected SBCC Theories.
Social change intervention: activities directed at changing conditions within the social environment.
Social convention: social conventions are at work when an individual follows a social rule, because of 1) expectations that many others follow the social
rule, 2) preference to do the same as others, and 3) compliance being in his/her interest. Influencing social conventions requires effort at the community
level because even if an individual or small family unit changes its practices, the social convention will still be in place. This is a concept from the social
norms theories in the Graphic: Concepts of Selected SBCC Theories.
Social distance: the number and importance of dissimilarities between providers and clients.
Social learning: learning that comes about as a result of socialization and observation of social norms –usually passive and unconscious.
Social marketing: application of commercial marketing techniques for consumerism to the promotion of health behaviors. This approach has four Ps:
product, price, place, and promotion. This is a concept from social marketing approaches in the Graphic: Concepts of Selected SBCC Theories
Social mobilization: a process of bringing together all feasible and practical intersectoral social partners and allies to determine felt‐need and raise
awareness of a demand for a particular development objective. It involved enlisting the participation of such actors, including institutions, groups, networks
and communities, in identifying, raising, and managing human and material resources, thereby increasing and strengthening self‐reliance and sustainability
to achievements.
Social movements: refers to collective actions by citizens to promote social changes in policies, laws, social norms, and values.
Social norms: rules that a group uses to discriminate between appropriate and inappropriate values, beliefs, attitudes, and behaviors – the do’s and don’ts
of society. They can be explicit or implicit. Failure to conform to norms can result in social sanctions and/or social exclusion. This is a concept from the social
norms theories in the Graphic: Concepts of Selected SBCC Theories.
Social skills: the ability to successfully negotiate acceptance of one’s behaviors by one’s peer group or society at large.
Socioecological model for change: Characteristic 2 of C‐Change’s SBCC framework. It views individual behavior as a product of multiple overlapping
individual, social, and environmental influences. This model helps to combine individual change with the aim to influence the social context in which the
individual operates.
Stakeholder: a person or group whose interests are affected by the outcome of an intervention.
Stereotype: an assumption about an entire group based on limited exposure to that group.
Stigma: the dishonoring, shaming, disgracing, and discriminating against an individual on the basis of a single characteristic, e.g. homelessness, HIV
infection, commercial sex work.
Strategic approach: the way you decide to package or frame what you are doing into a single recognizable program or campaign. The strategic approach is
one of the most important elements in a communication strategy, because it drives the program‐it tells you how the communication objectives work
together to create change or is a platform holding together your different channels and activities.
Strategic gender needs: legal and social conditions needed to create equality between women and men.
Strategy outline: a document that contains a summary of analysis, communication strategy, implementation plan, and monitoring plan.
Strategy: a coordinated and comprehensive set of activities aimed at achieving an objective.
Structures of social networks: social networks refer to a web of social relationships that surround and influence individuals. Certain network
characteristics, network functions and types of social support make a network effective. The structural characteristics of networks refer to several aspects:
the degree of homogeneity among members, resource exchange, emotional closeness, formal roles, knowledge, interaction among members, and power and
influence among members. This is a concept from social network and social support theories in the Graphic: Concepts of Selected SBCC Theories.
Subjective norms: indicates what ought to be done, and is one of the distinguished perceived norms. This is a concept from individual level theories in the
Graphic: Concepts of Selected SBCC Theories.
Susceptibility: individual, group, and general social predisposition to infection. This concept may be applied at any level, from an entire society or country to
a household. Thus, individuals, nations, and societies are more or less susceptible to infection, and the speed and extent of the spread of HIV will be
determined by the susceptibility.
Synergy: the added benefit you get from activities or materials which enhance each other.
T
Theory: a systematic and organized explanation of events or situations. Theories are developed from a set of concepts (or “constructs”) that explain and
predict events/situations, and provide explanations about the relationship between different variables.
Theory of Change (TOC): “concrete statements of plausible, testable pathways of change that can both guide actions and explain their impact” (Kubisch et
al., 2004).
Three key strategies: characteristic 3 of the SBCC framework which includes an appropriate mix of the following strategies to address change at all levels
of the Socio‐Ecological Model. These key strategies are mutually reinforcing: advocacy, social mobilization, and behavior change communication.
Tipping point: the dynamics of social change where trends eventually become permanent change. They can be driven by a naturally occurring event or a
strong determinant for change, such as political will that can provide the final energy to “tip over” a situation to change – they are events that prompt
change. This is a concept from the social norms theories in the Graphic: Concepts of Selected SBCC Theories.
Tools: any instrument (e.g. worksheet, checklist, or graphic) that assists or guides practitioners in the understanding and application of concepts in their
programmatic work.
Transformative change: critical points that caused major transformations in a given community.
Trend: a pattern in frequencies of disease incidents or prevalence over time, within or across various subgroups.
V
Values: a cross‐cutting factor. Deeply held feelings/beliefs that shape choices and behaviors of individuals and communities. This is a concept from the
individual level theories in the Graphic: Concepts of Selected SBCC Theories
Vulnerability: those features within a society/community that make it more or less likely that its members will be disproportionately impacted by an
adverse condition –like HIV and AIDS; vulnerability analysis focuses on political, social, cultural and economic factors influencing health behavior.
W
WUNC displays: refers to participants’ concerted public representation of Worthiness, Unity, Numbers, and Commitment in relation to social movement
theories.
i Adapted from:
International HIV/AIDS Alliance/International Council of AIDS Service Organizations. Without Date. Advocacy in action: A toolkit to support NGOs and CBOs
responding to HIV/AIDS. Brighton: Progression.
Becker, Antje. 1998. Community health communication: Guidelines through the maze of IEC methods. Germany: GTZ
Glanz, K., Barbara K. Rimer, and K. Viswanath. Eds. 2008. Health behavior and health education: Theory, research and practice (Fourth Edition). San Francisco:
Jossey‐Bass, Inc.
Howard‐Grabman, L.H. and G. Snetro.2003. How to mobilize communities for health and social change. Baltimore, MD: Health Communication Partnership.
McKee, Neill, Erma Manoncourt, Chin Saik Yoon, and Rachel Carnegie (eds.). 2000. Involving people, evolving behavior. New York: UNICEF; Penang: Southbound.
National Cancer Institute. 2001. Making health communication programs work. A planer’s guide. Bethesda: National Institutes of Health.
O’Sullivan, Gael, Joan Yonkler, Win Morgan, and Alice Payne Merritt. 2003. A field guide to designing a health communication strategy. Baltimore: Johns Hopkins
Bloomberg School of Public Health/Center for Communications Programs.
Fertman, Carl. I. and D. Allensworth. Eds. 2010. Health Promotion Programs: From Theory to Practice. San Francisco: Jossey‐Bass, Inc.
Supplemental Readings
References in Facilitator Preparation
Caroselli, Marlene. 1998. Great openers, closers, and energizers. New York: McGraw Hill.
Sparks creative juices and provides ideas on designing a short activity to open, close, or energize a group.
International HIV/AIDS Alliance. 2002. 100 ways to energise groups: Games to use in workshops, meetings and the community. Brighton, UK:
Progression.
Compiles energisers, icebreakers, and games that can be used by anyone working with groups, whether in a workshop, meeting, or community setting.
Kaner, Sam, Lenny Lind, Catherine Toldi, Sarah Fisk, and Duane Berger. 2007. Facilitator’s guide to participatory decisionmaking. 2nd ed. San
Francisco: Jossey‐Bass.
Presents tools to facilitate workshops in a participatory manner and insights into group dynamics and group work.
McKee, Neill, Maruja Solas, and Hermann Tilllmann. 1998. Games and exercises: A manual for facilitators and trainers involved in participatory group
events. New York: UNICEF.
Offers games and exercises grouped around areas such as team building, conflict management, gender analysis, creativity, and evaluation.
Salas, Maria, Hermann Tillmann, Neill McKee, and Nuzhat Shahzadi. 2007. VIPP: Visualisation on participatory programmes: How to facilitate and
visualise participatory group processes. Dhaka: UNICEF.
Provides comprehensive guidance on the VIPP process and guidelines that are generalizable to different aspects of learning‐centered facilitation.
Schwarz, Roger. 2002. The skilled facilitator. Rev. ed. San Francisco: Jossey‐Bass.
Builds facilitation skills for workshops, meetings, organizational situations, and more.
Vella, Jane. 2002. Learning to listen, learning to teach: The power of dialogue in educating adults. Rev. ed. San Francisco: Jossey‐Bass.
Explains dialogue education and offers practical, universally applicable approaches to basic principles of adult learning that transcend cultural
differences.
King, Rachel. 1999. Sexual behavioural change for HIV: Where have theories taken us? Geneva: UNAIDS.
Presents a brief overview of theoretical models of behavioral change, a review of key approaches used to stem sexual transmission of HIV, a summary
of successful interventions targeting specific populations at risk, and a discussion of challenges.
National AIDS Coordinating Agency and African Comprehensive HIV/AIDS Partnership (ACHAP). 2005. Behaviour change interventions and
communications. A learnerdriven training programme piloted in Botswana. Gaborone: ACHAP.
Comprises a 10‐module course with assignments, readings, and worksheets on issues such as the national response to HIV and AIDS, research tools,
communication strategies, monitoring plans, and assignments on gender, including explanations of key concepts in gender education, gender
analysis, and gender equity promotion.
O’Sullivan, Gael, Joan Yonkler, Win Morgan, and Alice Payne Merritt. 2003. A field guide to designing a health communication strategy. Baltimore: Johns
Hopkins Bloomberg School of Public Health/Center for Communications Programs.
Conveys practical guidance for those designing, implementing, or supporting a strategic health communication effort, with an emphasis on
developing a comprehensive, long‐term approach that responds appropriately to audience needs.
Policy Project. 2003. Moments in time: HIV/AIDS advocacy series. Washington, DC: USAID.
Highlights moments in many HIV/AIDS global advocacy efforts from the perspective of those involved; a companion to other training materials
Rimer, Barbara, and Karen Glanz. 2005. Theory at a glance. A guide for health promotion practice. 2nd ed. Washington, DC: National Cancer Institute.
Provides information and examples of influential theories of health‐related behaviors, the processes of shaping behaviors, and the effects of
community and environmental factors on behavior.
Additional Readings for Module 0: Introduction
Chen, Peter. 2006. Planning BCC interventions: A practical handbook. Bangkok: UNFPA CST.
Responds to the need of UNFPA to help colleagues and partners plan and implement effective BCC strategies in support of reproductive health,
adolescent reproductive health, and HIV prevention.
Global HIV Prevention Working Group. 2008. Behavior change and HIV prevention: (Re)considerations for the 21st century. n.p.: Global HIV Prevention
Working Group.
Based on a review of hundreds of studies, demonstrates the robust evidence base for behavioral HIV prevention and the documented effectiveness of
these interventions in numerous settings among diverse populations.
Linkages Project. 2004. Behavior change communication for improved infant feeding: Training of trainers for negotiating sustainable behavior change.
Washington, DC: AED.
Offers training in BCC for community health workers and their trainers to improve infant feeding.
Medical Care Development International/AED. 2008. HIV/AIDS capacity building and technical assistance field training for behavior change
communications. Washington, DC: AED.
Designed for a three‐day training and two‐day refresher training for healthcare professionals, community activists, and government officials in
Lesotho on revising BCC strategies and developing BCC interventions at the community level.
O’Sullivan, Gael, Joan Yonkler, Win Morgan, and Alice Payne Merritt. 2003. A field guide to designing a health communication strategy. Baltimore: Johns
Hopkins Bloomberg School of Public Health/Center for Communications Programs.
Provides practical guidance for those designing, implementing, or supporting a strategic health communication effort that emphasizes a
comprehensive, long‐term approach that responds appropriately to audience needs.
Roberts, Ann, Reynaldo Pareja, Will Shaw, Barbara Boyd, Elizabeth Booth, and Jose Ignacio Mat. 1995. A toolbox for building health communications
capacity. Washington, DC: AED/USAID
Provides a toolbox that can be used without a facilitator or in a facilitated learning process.
International HIV/AIDS Alliance/International Council of AIDS Service Organizations. n.d. Advocacy in action: A toolkit to support NGOs and CBOs
responding to HIV/AIDS. Brighton, UK: Progression.
Provides practical assistance on undertaking advocacy and assists NGOs and CBOs to gain a clear understanding of what advocacy is and how it might
support their work.
Mamimine, Patrick, Sara Page, and Lois Chingandu. 2008. Interlinkages between culture, GBV, HIV and AIDS and women’s rights. Harare:
SAfAIDS/Oxfam International.
Explores theories on culture in a training manual that offers an analytical model for interventions related to culture, gender‐based violence, women’s
rights, and HIV and AIDS.
McKee, Neill, Erma Manoncourt, Chin Saik Yoon, and Rachel Carnegie. 2000. Involving people, evolving behavior. Penang: Southbound/UNICEF.
Offers theories and frameworks for creating an enabling environment, including policy and legislation, service provision, education systems, cultural
factors, religion, socio‐political factors, and behavior and beyond: an evaluation perspective
Soul City Institute for Health and Development Communications. 2003. Qualitative target audience formative research for health and development
communication: Soul city fieldworker training manual 1. Qualitative interviewing. Johannesburg: Soul City Institute.
Developed to support skills‐training in qualitative interviewing and formative audience research.
Wallace‐Karenga, Katrina, Lois Chingandu, Sara Page, and Rouzeh Eghtessadi, eds. 2009. Mainstreaming HIV, AIDS and gender into culture: A
community education handbook. Part 1 and 2. Harare: SAfAIDS.
Encourages discussion about how people behave together and cope with HIV; how culture can affect the spread of HIV; and how culture, gender, and
HIV are connected.
Wilson, David. 2001. HIV/AIDS rapid assessment guide. Arlington, Va.: Project Support Group/Family Health International.
Consists of five HIV‐prevention tools: a mapping guide, a site inventory, an ethnographic guide, a focus group guide, and a guide to rapid behavioral
surveys, which can be used to collect data that provide a spatial, quantitative, and qualitative overview of a project area.
Additional Readings for Module 1: Understanding the Situation
AfriComNet and HCP/CCP. 2006. Training of trainers on strategic communication and HIV and AIDS: Facilitator’s guide. Kampala: AfriComNet.
Designed to assist a facilitated five‐day training on the basics of HIV and AIDS strategic communication, HIV and AIDS stigma and discrimination,
research, M&E for HIV and AIDS communication programs, use of demographic and health surveys for health programming, applied skills in HIV
communication and counseling, and community mobilization for health and development.
Howard‐Grabman, Lisa, and Gail Snetro. 2003. How to mobilize communities for health and social change. Baltimore: Johns Hopkins Bloomberg School
of Public Health/Center for Communication Programs.
Provides guidance for directors and managers of community‐based health programs who are considering communication mobilization at individual,
family, and community levels.
O’Sullivan, Gael, Joan Yonkler, Win Morgan, and Alice Payne Merritt. 2003. A field guide to designing a health communication strategy. Baltimore: Johns
Hopkins Bloomberg School of Public Health/Center for Communications Programs.
Shares steps and tools for the strategic development of health communication and BCC efforts in which all stakeholders participate.
Price, Leigh, Patrick Mamimine, and Lois Chingandu. 2009. Changing the river’s flow series: Zimbabwean stories of “best practice” in mitigating the HIV
crisis through a cultural and gender perspective. Harare: SAfAIDS/Oxfam International.
Presents a collection of best practices from six CBOs in Zimbabwe that implemented innovative strategies and approaches in gender programming
through a culture lens.
Rimer, Barbara, and Karen Glanz. 2005. Theory at a glance. A guide for health promotion practice. 2nd ed. Washington, DC: National Cancer Institute.
Provides information on and examples of influential theories of health‐related behaviors, the processes of shaping behaviors, and the effects of
community and environmental factors on behavior.
Salem, Ruwaida, Jenny Bernstein, and Tara Sullivan. 2008. Tools for behavior change communication. INFO Reports 16: 1–8.
Offers tools that assist the planning and development of a BCC component in family planning programs.
Sharma, Ritu. 1997. An introduction to advocacy: Training guide. Washington, DC: Academy for Educational Development.
Designed for training sessions, but can also be used for self‐teaching and includes a framework that can be used to develop an advocacy campaign.
Zambesi, Rose, and Juan Hernandez. 2006. Engaging communities in youth reproductive health and HIV projects: A guide to participatory assessments.
Arlington, Va.: Family Health International.
Provides guidelines for carrying out participatory assessments with young adult community members and outlines various tools and methods that
can be applied.
Additional Readings for Module 2: Focusing & Designing
AIDS Control and Prevention (AIDSCAP) Project. n.d. How to create an effective communication project. Arlington, Va: Family Health International.
Guides users through the use of an AIDSCAP strategy to develop effective BCC interventions.
Additional Readings for Module 3: Creating
Rimer, Barbara, and Karen Glanz. 2005. Theory at a glance. A guide for health promotion practice. 2nd ed. . Washington, DC: National Cancer Institute.
Provides information and examples of influential theories of health‐related behaviors, the processes of shaping behaviors, and the effects of
community and environmental factors on behavior.
Additional Readings for Module 4: Implementing and Monitoring
AIDSTAR‐One. 2009. Integrating multiple gender strategies to improve HIV and AIDS interventions: A compendium of programs in Africa. Washington,
DC: ICRW/USAID.
Summarizes global program efforts to integrate various gender strategies to improve HIV and AIDS interventions.
IMPACT Project. 2004. Monitoring HIV/AIDS programs: A facilitator’s training guide and participant resources. Arlington, Va: Family Health
International.
Designed to build skills for conducting M&E activities.
USAID. 2002. Expanded response guide to core indicators for monitoring and reporting on HIV/AIDS programs. Washington, DC: USAID.
Offers an expanded M&E system for national and USAID programs whose first priority is rapid scale‐up in intensive‐focus countries.
Horizons Project. 2008. Horizons operations research on HIV/AIDS toolkit. Washington, DC: Population Council.
Provides the tools and information needed to design a successful HIV‐related operations research study, from developing the research protocol to
analyzing and reporting on results.
IMPACT Project. 2004. Monitoring HIV/AIDS programs: A facilitator’s training guide and participant resources. Arlington, Va.: Family Health
International.
Builds skills for conducting M&E activities through three core modules and seven program‐specific modules, including one on BCC.
Pulerwitz, Julie, and Gary Barker. 2008. Measuring attitudes toward gender norms among young men in Brazil: Development and psychometric
evaluation of the GEM scale. Men and Masculinities 10.3: 322–338.
Describes the development and psychometric evaluation of the Gender‐Equitable Men (GEM) Scale—a 24‐item scale to measure attitudes toward
young men’s gender norms related to sexual and reproductive health, sexual relations, violence, domestic work, and homophobia.
Ullin, Pricilla, Elizabeth Robinson, and Elizabeth Tolley. 2002. Qualitative methods: A field guide for applied research in sexual and reproductive health.
San Francisco: Jossey‐Bass.
Covers theory, research design and methodology, data collection, data analysis, writing, and research dissemination for social scientists, public health
specialists and research teams interested in using qualitative methods to study sexual and reproductive health.
Weiss, William, and Pat Bolton. 2000. Training in qualitative research methods for PVOs and NGOs. Baltimore: Johns Hopkins University Bloomberg
School of Public Health/Center for Refugee and Disaster Studies.
Provides a trainer’s guide and participant’s manual that promote the systematic use of qualitative methods in planning and managing community
health programs.
Additional Readings for Module 5: Evaluating and Replanning
Adamchak, Susan, Katherine Bond, Laurel MacLaren, Robert Magnani, Kristin Nelson, and Judith Seltzer. 2000. A guide to monitoring and evaluating
adolescent reproductive health programs. FOCUS Tool Series #5. Arlington, Va.: Family Health International.
Designed for program managers who monitor and evaluate adolescent reproductive health programs.
Aubel, Judi. 1999. Participatory program evaluation manual: Involving program stakeholders in the evaluation process. 2nd ed. Calverton, Md: Catholic
Relief Services/ORC Macro.
Bertrand, Jane, and Amy Tsui. 1995. Indicators for reproductive health program evaluation: Introduction. Chapel Hill: Carolina Population Center.
Introduces the Reproductive Health Indicators Working Group (RHIWG), whose subcommittees developed a series of indicators for safe pregnancy,