Social and Behavior Change Communication (SBCC)

1. Social and Behavior Change Communication (SBCC) Module 14 Version 2

2. Learning objectives • By the end of this module, learners will be able to: • Identify reasons why people change or do not change behavior easily • Define SBCC • Differentiate between SBCC and information, education, and communication (IEC)

3. Learning objectives, cont. • Discuss: • Basic SBCC concepts and methods • Key messages related to community-directed intermittent preventive treatment in pregnancy that can be promoted through SBCC • Ways to use SBCC to promote acceptance of community-directed intermittent preventive treatment in pregnancy among target audiences, such as: • Policymakers • Frontline health care providers • Community members

4. SBCC introduction:Brainstorming session 1 How can people avoid getting malaria?

5. SBCC introduction:Brainstorming session 2 Are people behaving in these ways?

6. Why do people not change behavior? • May not understand message • May not see themselves as vulnerable • Prepared to take risk now and deal with consequences later • Life is hard, one more risk does not make much difference • Behavior not necessarily based on rational thought • After all, malaria is a common disease

7. SBCC builds on IEC

8. Difference between IEC and SBCC • Experience has shown that providing people with information and telling them how they should behave (“teaching” them) is not enough to bring about behavior change. • While providing information to help people to make a personal decision is a necessary part of behavior change, SBCC recognizes that behavior is not only a matter of having information and making a personal choice. Behavior change also requires a supportive environment. • Community and society provide the supportive environment necessary for behavior change.

9. Exercise time • Duration: 5 mins • Work in pairs • List some ways of creating a supportive environment for appropriate health behavior

10. Example ways to create a supportive environment for appropriate health behavior • Direct political action to create policies and regulations, such as tobacco control legislation • Providing financial incentives or disincentives, for example, sponsoring alcohol-free events • Advocacy designed to gain political commitment, social acceptance, or policy change, for example, supporting community groups to advocate banning junk food advertising to children

11. Example ways to create a supportive environment for appropriate health behavior, cont. • Providing education and empowerment, and enabling communities and individuals to take control of their health and environment, for example, teaching people in a disadvantaged community the skills to research local health needs • Strengthening links between health and environmental strategies, including creating partnerships, for example, working with sustainable living practices and implementing walking or cycling programs

12. Example ways to create a supportive environment for appropriate health behavior, cont. • Ensuring equitable access to supportive environments for health by mediating between conflicting interests in society, for example, promoting sexual health and well-being for people with disabilities being inclusive in plans involving community • Being inclusive in plans involving community members and staff, for example, consulting community members to identify the best approaches to health and well-being

13. Example ways to create a supportive environment for appropriate health behavior, cont. • Creating supportive settings for people using health services, for example, making waiting rooms feel welcoming for people with friendly staff, seating, play areas for children, access to water, and promotion of the role of the arts in health • Promoting health in the workplace, for example, implementing stress management programs for staff, helping staff quit smoking, or providing healthy snack options in vending machines. Source: Department of Health and Human Services 2018.

14. The SBCC process A process of promoting and sustaining healthy changes in the behavior of individuals and communities through participatory development of appropriately tailored health messages and approaches that are conveyed through a variety of communication channels

15. SBCC and malaria Before individuals can reduce their risk/change behaviors, they must:

16. What can SBCC do? • Increase knowledge • Stimulate community dialogue • Promote essential changes in attitudes • Reduce stigma and discrimination • Create a demand for information and services • Advocate • Promote services for prevention, care, and support • Improve community members’ skills and sense of self-efficacy

17. Exercise: Discuss terms for common physiological symptoms in pregnancy

18. Several diseases are associated with fever (hot body) • In malaria the fever comes with chills, aches and comes at the same time each day, often between late morning and evening • Severe malaria may come with convulsions/fits, unconsciousness • In pneumonia the fever can come with cough, fast or difficult breathing

19. Since many diseases can cause fever, we need a way to test the real cause • If we give the wrong medicine for the disease, the pregnant woman will not get well • There is a special malaria blood test we can do in the community called rapid diagnostic test (RDT)

20. Using RDTs • Health care workers in the health facility (and community health workers in some countries) have been trained to use the RDT correctly and safely • Only a few drops of blood are needed to find out if the malaria parasites are in the blood • It takes only 15 minutes for the test result to be ready

21. Positive and negative RDT results A line in “T1” or “T2” and a line in “C” means the patient has malaria: No line in “T1” or “T2” but a line in “C” means the patient does not have malaria: C T2 T1 T2 C T1 Positive for malaria Negative for malaria

22. Treatment • We only give malaria medicine when the RDT is positive • New malaria medicines should not be wasted when the test is negative (which means the person does not have malaria) • If the test is negative, we look for another cause of fever and treatment

23. Basic SBCC methods • Visual aids • Story telling • Use of songs • Role-play and village drama Civil society organizations can be engaged to help implement basic SBCC methods in the community!

24. Visual aids • Visual aids help to enhance understanding, and these include: • Posters • Counseling cards • Flip charts • Video Give pregnant woman three sulfadoxine-pyrimethamine tablets monthly beginning from 13+ weeks (or after baby has started moving in her womb) using directly observed therapy.

25. Examples of community counseling cards Give all pregnant women three sulfadoxine-pyrimethamine tablets beginning from 4 months (only after baby has started moving in her womb) Use artemisinin-based combination therapy when you have malaria fever Every member of your household (especially pregnant women and children under the age of 5 years) must sleep inside insecticide-treated nets.

26. Story telling • Stories facilitate understanding • Through this medium, traditions, values, and norms of society are passed down across generations • Examples of stories may include: • Folktales relating to malaria disease (for example, how wrong understanding of malaria causation led to death of a child or pregnant woman) • Testimonies (such as how RDTs helped to confirm malaria and aided treatment to prevent death) • Cartoon stories

27. Use of songs • Songs reinforce knowledge and help to internalize understanding • You can compose original songs or graft lyrics (words) about malaria in pregnancy onto melodies (music) of familiar songs • Using songs in this way helps community members understand key health messages, such as benefits of attending antenatal care and preventing malaria in pregnancy • Create lyrics in local languages, if possible, to increase the community’s sense of ownership and investment in solving the issues

28. Role-play and village drama • Role-play/drama builds people’s confidence in performing a skill or practice • When people watch neighbors or colleagues perform an action, skill, or practice, it boosts their courage that they too can do so • This can best be explained with the social learning theory using driving and use of seat belt (Bandura 2004)

29. Summary • Experience has shown that providing people with information and telling them how they should behave is not enough to bring about behavior change. • SBCC recognizes that behavior is not only a matter of having information and making a personal choice but that it also requires a supportive environment. • Communities and society provide the supportive environment necessary for behavior change. • Visual aids such as posters, counseling cards, flip charts, and videos help to enhance understanding.

30. References • Bandura A. 2004. Observational learning. In: Byrne JH, ed. Learning and Memory. 2nd ed. New York, NY: Macmillan Reference USA; 482–484. http://link.galegroup.com/apps/doc/CX3407100173/GVRL?u=cuny_hunter&sid=GVRL&xid=571b1693. Accessed November 14, 2018. • Department of Health and Human Services (DHHS) [Tasmania]. 2018. Supportive environments. DHHS website. http://www.dhhs.tas.gov.au/wihpw/principles/supportive_environments. Accessed November 14.

31. Thank you! Any questions or comments?