CDI Module 19:

Behavior Change Communication

Jhpiego Corporation
The Johns Hopkins University
A Training Program on Community-
Directed Intervention (CDI) to Improve
Access to Essential Health Services
Module 19 Objectives

By the end of this module, learners will

Define Behavior Change Communication (BCC)
Differentiate between BCC and Information, Education and
Communication (IEC)
Identify reasons why people change or do not change behavior
easily
Discuss basic issues and concepts in BCC
State key BCC-centered messages to promote acceptance of
integrated community case management (iCMM) by
policymakers, frontline health care providers and community
members
Identify basic methods of communicating BCC-centered
messages to the target audience
2
Basic Issues

Basic
Concepts and
Messages for
iCCM Basic BCC
Methods for
iCCM

3
Basic Concepts

4
Introduction to Behavior Change

Learners Brainstorm
How can people avoid Are people behaving in
getting malaria? these ways? No! But
WHY?

[Post these as flip

chart pages]
5
Why Do People NOT Change Behavior?

People may not

Understand the message
See themselves as vulnerable
Trust the bearers of the message
People may
Think the short-term benefits of current behaviors outweigh the
long-term risks
Some healthy choices are costly
Recommended behavior may conflict with beliefs
After all, people believe that malaria is a common
disease and is not so serious
Can you name more reasons?
6
Information, Education and Communication
(IEC)
IEC is a process of working with individuals,
communities and societies to develop
communication strategies
These strategies support positive behaviors that
Promote health
Are appropriate to their settings

7
Behavior Change Communication (BCC)

BCC
Develops communication strategies
To promote positive behaviors that are appropriate to
their settings
AND
Provides a supportive environment that
Will enable people to initiate and sustain positive
behaviors

8
What Makes an Environment Supportive?

What can
Families do?
Local organizations do?
Community leaders
do?
Health workers and
managers do?
Policymakers do?

Who else can contribute to a supportive environment?

9
Therefore, BCC Is

a process of promoting
and sustaining healthy
changes in behavior in
individuals and communities
This process calls for
participatory development of
appropriately tailored health
messages and approaches
These messages and
approaches are conveyed
through a variety of
communication channels

10
Using BCC to Promote Malaria Action

11
BCC and Malaria

Before individuals can reduce their risk/change behaviors

they need to
Understand basic facts about malaria
Develop favorable attitudes toward preventive interventions
Long-lasting insecticide-treated nets (LLINs)
Intermittent preventive treatment in pregnancy (IPTp)
Indoor residual spraying (IRS)
Learn a set of skills to implement interventions
Have access to appropriate commodities and services
Perceive their social, economic and political environment to
be supportive of practicing malaria prevention behaviors

12
What Can BCC Do?

Increase knowledge Create demand for

about malaria information and malaria
Stimulate community services
dialog to stop malaria Advocate for more
Promote essential malaria resources
attitude change toward Promote services for
malaria prevention prevention, care and
support
Reduce stigma and
Improve skills and sense
discrimination against
of self-efficacy in using
poor people who suffer
malaria interventions
frequently from malaria
Can you name more? 13
Before We Communicate about and Manage Common
Illnesses, We Need to Know Their Local Names

Medical Name Local Name(s) How Differs

from Malaria
Malaria
Pneumonia
Diarrhea
Catarrh/Cold
Cough
Rashes
Measles 14
Prevention Challenges

What if people believe

that malaria is caused
by hard work under
the hot sun, and only
herbal concoctions
can prevent it?
What if people think
nets are hot and
uncomfortable?
What can BCC do?
15
More Prevention Challenges

What if people use their nets for other purposes?

What can BCC

16 do?
Treatment Challenges

Several Diseases Have Hot Body (Fever)

In cases of malaria, the
fever comes
With chills and aches and
At the same time each
day, often between late
morning and evening
In cases of pneumonia, the
fever can come
With a cough and fast or
difficult breathing
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Many Diseases Can Have Fever

So We Need a Way to Test

If we give the wrong
medicine for the
disease, the child will
not get well
We can do a special
malaria blood test called
rapid diagnostic test
(RDT)
We can do the RDT in
the community
18
Using RDTs

Your community-directed
distributor (CDD) has
been trained to use the
RDT correctly and safely
Only a few drops of blood
are needed to find out if
the malaria germs are
in the blood
Most RDT results are
ready in only 15 minutes

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Positive and Negative RDT Results

Lines in T1 and T2 NO LINE in T1 or T2

and a line in C means but a line in C means
C T1 T2 C T2
T1

Pf or Mixed + Negative

the patient DOES have the patient DOES NOT

falciparum malaria have either falciparum
monoinfection or a mixed malaria or non-falciparum
infection malaria
20
Treatment

We only give malaria

medicine when the
RDT is positive
New malaria medicine
should not be wasted
when the person does
not have malaria
If the test is negative,
we look for another
disease and treatment
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The Communication Challenge

What if the RDT says

the person does not
have malaria, but she
believes she has it
and demands malaria
medicine?
What can we do?
How can we use BCC
to solve this problem?

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Basic BCC Methods

23
Different BCC Methods
Address Different Challenges
How Method Helps Change
Method
Behavior
Posters, counseling
Provide information
cards, brochures
Remind people about malaria
Radio, TV, songs
action
Present role models for
Stories, dramas, plays
behavior change
Provide opportunities to plan
Discussions
for solving problems 24
Using Visual Aids

Visual aids help to

enhance
understanding
Visual aids include
Posters
Counseling cards
Flip charts
Videos

25
 Community Counseling Card

Give all pregnant women 3 SP Every member of your household

Use artemisinin-based
tablets beginning from 4 (especially pregnant women and
combination therapy (ACT)
months (MUST be given after children under the age of five years)
when you have malaria
baby started moving in MUST sleep under insecticide-treated
fever 26 26
mothers womb) nets
Telling Stories

Stories facilitate understanding and are used to

pass down a societys traditions, values and norms
to future generations
Stories could include
Folktales relating to malaria disease, (e.g., how
misunderstanding the cause of malaria led to the
death of a child or pregnant woman)
Testimonials (e.g., how RDTs helped to confirm
malaria and aided treatment to prevent death)
Cartoon stories

27
Composing Songs

Songs reinforce knowledge and help to

internalize understanding
Adapting or composing songs about RDT use
can help villagers
Understand how they can benefit from using RDTs
and accept use
Feel comfortable being tested with RDTs
Songs composed in the local language convey
ownership and make issues indigenous

28
Role Play and Drama

Theories about behavior change, for example,

propose that people develop confidence and
willingness to perform a new behavior when they
can observe others in their community doing the
same
Therefore, role play and drama can build
peoples confidence in performing a new skill or
practice

29
Community Discussion and Planning

Communities need to
be actively involved in
solving their own
malaria problems
Communities can
plan how to distribute
nets
Communities can
select volunteers to
treat malaria
What else can your communities do? 30
Reminder: Some Basic Information

Understanding the signs and symptoms of a disease

may enhance its prevention and treatment
In cases of malaria, fever may come with chills and
aches; malaria fever comes at the same time each
day, often between late morning and evening
In cases of pneumonia, fever can come with a
cough and fast or difficult breathing
If we give the wrong medicine for the disease, the
child will not get well
This is why we carry out a special malaria blood
test, called RDT, at the facility and community levels
31
Reminder: More Basic Information

This test (the RDT) will help us to know the

cause of fever so that we can give the
appropriate medicine to your child
The test is safe, and your CDD has been trained to
carry out the test correctly and safely
Be sure to complete the dosage of artemisinin-
based combination therapy (ACT) given to you
or your ward, even though the fever has stopped
This new medicine is safe for everyone

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Reminder: With BCC,
Information Alone Is Not Enough
We can help create a supportive environment by
Holding community meetings to plan malaria
control activities
Ensuring that the health services have adequate
supplies of nets and medicines
Advocating with decision-makers at district,
regional and national levels to make funds
available to control malaria
Making sure that malaria interventions do not
cost more than people can afford
33
Small Group Activities

Divide the learners into three groups that will

focus on
Promoting use of insecticide-treated nets
(ITNs)/LLINs
Seeking prompt diagnosis and correct malaria
treatment
Getting IPTp as part of antenatal care (ANC)
Ask each group to plan a BCC program on their
topic using locally available materials and media
Groups will report back by sharing their plan and
showing examples of their BCC activities
34