CDI Module 19:
Behavior Change Communication
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected 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 BCCcentered 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
getting malaria?
[Post these as flip
chart pages]
Are people behaving in
these ways? No! But
WHY?
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
about malaria
 Stimulate community
dialog to stop malaria
 Promote essential
attitude change toward
malaria prevention
 Reduce stigma and
discrimination against
poor people who suffer
frequently from malaria
 Create demand for
information and malaria
services
 Advocate for more
malaria resources
 Promote services for
prevention, care and
support
 Improve skills and sense
of self-efficacy in using
malaria interventions
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
Others?
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 do?
16
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
17
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 communitydirected 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
19
Positive and Negative RDT Results
Lines in “T1” and “T2”
and a line in ‘C’ means
C
T1
T2
Pf or Mixed +
the patient DOES have
falciparum malaria
monoinfection or a mixed
infection
NO LINE in “T1” or “T2”
but a line in “C” means
C
T1
T2
Negative
the patient DOES NOT
have either falciparum
malaria or non-falciparum
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
21
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?
22
Basic BCC Methods
23
Different BCC Methods
Address Different Challenges
Method
How Method Helps Change
Behavior
Posters, counseling
cards, brochures
Provide information
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
Peer groups
Provide encouragement
24
Using Visual Aids
 Visual aids help to
enhance
understanding
 Visual aids include
 Posters
 Counseling cards
 Flip charts
 Videos
25
Community
Counseling Card
Use artemisinin-based
combination therapy (ACT)
when you have malaria
fever
Give all pregnant women 3 SP
tablets beginning from 4
months (MUST be given after
baby started moving in
mother’s womb)
Every member of your household
(especially pregnant women and
children under the age of five years)
MUST sleep under insecticide-treated
26 26
nets
Telling Stories
Stories facilitate understanding and are used to
pass down a society’s 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
people’s 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 artemisininbased combination therapy (ACT) given to you
or your ward, even though the fever has stopped
 This new medicine is safe for everyone
32
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