INTRODUCTION:

Behavior Change Communication (BCC) programs are designed to bring about behaviors that will improve health status and related long-term outcomes. Previously known as Information- Education-Communication (IEC), the change in name implies a switch from materials production to strategically designed programs that influence behavior.¹ BCC is a set of organized communication interventions and processes aimed at influencing social and community norms and promote individual behavioral change or positive behavior maintenance for a better quality of life.²

Definition of Behavior Change Communication:

BCC is a process of working with individuals, families and communities through different communication channels to promote positive health behaviors and support an environment that enables the community to maintain positive health behaviors taken on.³

BCC programs include a wide range of interventions that fall into three broad categories:

· Mass media

· Interpersonal communication and

· Community mobilization.

Any of these three types of communication can generate the results measured by these core indicators, including changes in knowledge, attitudes, intentions, and behavior.¹

BCC Moves People from Awareness to Action!:

This paradigm shift from IEC to BCC interventions implies not just a categorical change, but more importantly, a conceptual and programmatic refocusing on the strategic elements of social and behavioral change.² For some time it has become clear that while IEC programs have resulted in improved health knowledge they have often failed to produce behavior change. IEC campaigns are often better at imparting knowledge and information than they are at moving people from awareness to action. Behavior change is a complex process motivated by many factors including:

· A persons awareness of the need to change,

· A persons understanding of the benefits of such a change,

· A persons belief in their ability to change

· A person having the confidence in their ability to maintain a behavior change.

To be successful, BCC must move people from awareness to action by motivating people to believe that health benefits will be obtained by changing behavior and by increasing individuals’ sense of control over their own health behavior choices. BCC must go beyond just providing information to an approach that provides both information and appeals to individuals emotions. With this understanding the following elements have been identified as being crucial to the success of BCC health messages and programs.

Elements of BCC:

The rational element, based on knowledge:

People need to know the basic facts about a health issue.

The emotional element, based on the intensity of attitudes or feelings:

Individuals need to feel an intense and personal vulnerability to the cause or threat.

The practical element, based on personal skills in a new behavior:

People need to be competent in practicing the new behavior and be confident in their ability to do so. They need a sense of self-efficacy to adopt new, health-protective behaviors.

The interpersonal element, or social networks: People need to associate with and be supported by their significant others (such as family members and peer groups) whose knowledge, emotions and skills can reinforce healthy behavior changes.

The structural element, or the social, economic and legal context in which behavior takes place: People need to have access to necessary supplies and services and to live in an environment where safer behaviors are accepted and promoted while risky behaviors are discouraged.

Behavior Change Communication Approaches:

Individual Approaches:

Behavior Change Communication on a one-to-one basis is continues to play an important role particularly in the area of secondary prevention and tertiary prevention. Individual methods in primary prevention are not as cost effective if you are targeting large target audiences although it can be useful in reducing risk factors for certain diseases.

The main methods of individually focused BCC are patient education and information, counseling and risk assessment/screening. These methods can occur in hospitals and community health centers, as well as in the community. The advantages of an individually focused activity are that they can be personalized and the health service provider is often seen as a credible source of information. There are also limitations. Individual approaches are time consuming, not cost effective and very labor intensive. However when applied at the right moment in the right way, individual methods can be highly effective.

Group Approaches

Group methods of Behavior Change Communication have been used widely and offer an intermediary approach between one-to-one approaches and wider community approaches. Group methods have been shown to have a role in assisting individuals to gain knowledge and change attitudes and behavior, as well as providing a supportive setting for people who may share a common goal. They can also play a role in assisting members of a community or organization to improve their ability in approaching their own health problems or getting them empowered to facilitate change within their community. For group approaches to BCC to be effective, an experienced facilitator or group leader is very important.

Community Approaches:

Community based approaches to Behavior Change Communication can potentially have a greater impact on a larger amount of people. One of the principles of BCC is work with individuals, families and communities to support an environment that enables the community to maintain positive health behaviors take on. BCC works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. By developing this principle some major changes can potentially be made at a community level as a result of community based BCC programs.³

Stages of Health Behavior change:

Health behavior Change is a cyclic phenomenon in which people progress through several stages. In the first stage, the person does not think seriously about changing a behavior; by the time the person reaches the final stage, he or she is successfully maintaining the change in the behavior. Several behavior change model have been proposed. The Tran theoretical Model (TTM), proposed by Prochaska, Redding, and Evers (2009) is discussed here. As shown in the fig1, the stages are a) Pre-contemplation, b) Contemplation, c) decision/ preparation, d) action, e) maintenance and f) termination.

Pre-contemplation Stage:

In this precontemplation stage, the person does not think about changing his or her behavior in the six months. They may be uninformed or under informed about the consequences of the risk behavior(s). The person who has tried changing previously and was unsuccessful may now see the behavior has his or her ‘fate’ or believe that change is hopeless. Individual in this stage tend to avoid reading, talking, or thinking about their high risk behaviors.

Contemplation Stage:

During the contemplation stage, the person acknowledge having a problem, seriously considers changing a specific behavior, actively gathers information, and verbalizes plans to change the behavior in the near future (e.g., next 6months). The person, however, may not be ready to commit to action. Some people may stay in the contemplative stage for months or years before taking action.

Preparation / Decision Stage:

The preparation stage occurs when the person intends to take action in the immediate future (E.g., within next month). Some people in this stage may have already started making small behavioral change. At this stage, the person makes the final specific plans to accomplish the change.

Action Stage:

The action stage occurs when the person actively implements behavioral and cognitive strategies of the action plan to interrupt previous health risk behavior and adopt new ones. This stage requires the greatest commitments of the time and energy.

Maintenance Stage:

During the maintenance Stage, the person strives to prevent relapse by integrating newly adopted behaviors into his or her lifestyle. This stage lasts until the person no longer experiences temptation to return to previous unhealthy behaviors. The relapse is usually to the pre-contemplation or contemplation stage.

Termination stage:

The termination stage is the ultimate goal where the individual has complete confidence that the problem is no longer a temptation or threat. It is as if they never acquired the habit in the first place or the new behavior has become automatic.⁴

The Conceptual Framework: How BCC Works:

In this conceptual framework of strategic communication and behavior change, communication is treated as an outside factor that affects the other variables in the model.

Communication designed to improve skills is identified as instruction, communication for removing environmental constraints is identified as advocacy, and communication designed to change ideational factors is identified as promotion. The model specifies how and why communication affects intention and behavior: indirectly through its effects on skills, ideation, and environmental constraints.

"Promotion" is central to this section, because it leads to ideational change (that is, a change in the way individuals or populations perceive given practices or behaviors). Promotion is designed to have cognitive, emotional, and social effects, which in turn influence a person's intent to practice a certain behavior and to follow through in doing so. The actual behavior is the "desired result" in almost all BCC programs, whatever the specific area or topic. Evaluators often label this behavior the "intermediate outcome".

In addition to obtaining data on the actual behavior, evaluators should collect data on all ideational variables that may be relevant to the behavior of interest. Communication is designed to affect ideational variables in order to change behavior. In a pre-post evaluation design, evaluators can compare baseline measures of these variables with post-intervention data. Also, they can assess program effects on the ideational variables by comparing the level of each variable among those exposed and unexposed to the communication program. Evaluators can then use results on the relationship between ideational variables and program exposure to track changes over time and to refine and/or reinforce the communication messages. Research has shown that ideational variables operate as "proximate determinants" and that communication can influence contraceptive use not only directly, but also indirectly through ideation (Kincaid, 2000; Babalola et al., 2001). Even if one can convince individuals that certain courses of action are desirable, environmental constraints to behavior change often exist-- in the form of politically based barriers, resource limitations, legal constraints, and other factors. Advocacy becomes a powerful tool to confront these constraints at the macro level and to minimize barriers to positive behavior at the individual level.¹

Communication Methods and Tools:

A successful BCC intervention uses various communication methods, including face-to-face communication, training, community media, mass media, information and communication technology (ICT), life-skills education, behavior modification, problem solving and counseling to develop the skills and capabilities of targeted audiences to manage their own health and development. Methods to foster positive changes in individual behaviors as well as increase knowledge and affect the attitudes of the intended audiences are needed.²

Evaluation of Behavior Change:

A variety of approaches, methods and tools can be used to evaluate health and behavioral changes. These includes questionnaires, rating scales, surveys, checklists, skill demonstrations, tests, subjective clients feedback and direct observation of improvements in client mastery of materials. Qualitative and quantitative strategy may be used depending on the nature of expected educational outcome. Evaluation of outcomes measures includes changes in knowledge, skills, ability, attitude, behavior, health status and quality of life.⁵

CONCLUSION:

Behavior Change Communication programs can be used to improve the positive health, reduce disease risks, manage chronic illness and improve the overall well-being of individuals, families and communities. It has been demonstrated that the ones most likely to succeed are those that are based on a very clear understanding of the targeted health behavior and the environmental context. There are many theories of health behavior and these theories have been helpful when planning, implementing and evaluating Behavior Change Communication interventions.³

REFERENCES:

1. Measure evaluation PRH Behavior Change Communication. Available from URL: http://www.cpc.unc.edu/measure/prh/rh_indicators/crosscutting/bcc

2. Chen P F. Planning Behavior Change Communication (BCC) Interventions: A Practical Handbook. Available from URL: http://www.academia.edu/4977987/Planning_BCC_Interventions_A_Practical_Handbook

3. Behavior Change Communication (BCC), Learning Resource Package Facilitator’s Guide. Available from URL: http://moph.gov.af/Content/Media/Documents/01_BCC_LRP-Facilitator'sManual-English17122011113814663553325325.pdf

4. Berman, Snyder, Kozier, Erb. Kozier and Erb’s Fundamental of Nursing: Concepts, Process and Practice. 8^th ed. Chennai. Pearson; 2011. p280-2

5. Stanhope M, Lancaster J. Public Health Nursing: population-centered Health Care in the Community. 7^th ed. Canada: Mosby Elsevier; 2004.p.311-2.

Received on 06.09.2015 Modified on 21.09.2015

Int. J. Nur. Edu. and Research.2016; 4(2):207-211.

DOI: 10.5958/2454-2660.2016.00041.7