Social and Behavior Change Communication (SBCC): Resources on Theory and its Application
Image credit: Adapted from McKee, Manoncourt, Chin and Carnegie (2000)
Over the past year, we have noted that many of you come to the C-Capacity website searching for resources on social and behavior change communication (SBCC) theories, models and approaches. Theories and models are essential for program planning; they offer conceptual tools that have been developed and refined over many years of empirical study that can guide the development of new interventions and strategies. Theories and models can help us formulate objectives as well as measurement indicators for behavior and social change interventions. The socio-ecological model (see graphic at left) is based on existing theories, models, and approaches from several disciplines, including political science, education, sociology, psychology, and communication. Through a synthesis of the information included in these theories and approaches, the socio-ecological model proposes several levels, or "layers," of influence to find effective tippin! g points for change. The resources on theory in this issue of C-Capacity are organized by these levels of influence: individual, interpersonal, community/social, and enabling environment. While this issue does not provide a complete or standard list of theories, models and approaches, the core resources below are both thought-provoking and part of current discussions in SBCC.
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About C-Capacity
C-Capacity is an e-magazine supported by C-Change and prepared by The Communication Initiative in cooperation with C-Change partner Ohio University. It is dedicated to alerting you and your organization to resources, training, links, and other opportunities for capacity strengthening in social and behavior change communication (SBCC), all vetted for quality and relevance by FHI 360 and Ohio University.
The C-Capacity Online Resource Center is a living resource designed to provide the best resources and training opportunities available and we welcome your contribution. We are looking for case studies, strategic thinking, support materials, trainings, meetings, and other resources relevant to SBCC capacity strengthening. To contribute, please contact cchangeorc@comminit.com
C-Change Capacity Strengthening News
1.C-Change Conducts SBCC Refresher Training with Partners in Southern Africa
C-Change facilitated a refresher training on SBCC with 21 partners from the Southern Africa AIDS Trust (SAT) network in October 2011. The refresher was the final training in a series of four and focused on key concepts in the C-Modules and facilitation skills. C-Change has been working with the SAT and their network of community-based organizations since 2010 to increase skills and competencies in SBCC through face-to-face trainings, technical assistance, and mentoring. The group of 21 trained SBCC practitioners will play a central role in using SBCC to strengthen their existing programs and introduce SBCC to the other SAT partners within their country networks.
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C-Channel is an e-newsletter produced by C-Change that showcases the impact of social and behavior change communication (SBCC) by presenting a selection of current, peer-reviewed journal articles about SBCC around family planning, reproductive health, HIV prevention, malaria prevention and control, and social and gender norms. C-Channel makes abstracts and full journal articles available free of charge to readers in the developing world, via email. See Issue 36 - More Peer-Reviewed Articles on Adapting SBCC Programs and Activities for more information. To subscribe, please go to the C-Channel main page and follow the instructions in the right column.
Jobs
2. Health Systems Specialist - USAID - Abidjan, Cote D'Ivoire
The Health Systems Specialist functions as Chief of the PEPFAR Cote D'Ivoire Health Systems Strengthening (HSS) Branch (office) and will assist PEPFAR CI to transition from an emergency to a more sustainable country program. S/he is one of six senior-level specialists/Branch Chiefs and reports directly to the USAID PEPFAR Country Director. The incumbent will design and oversee implementation of health sector reform and related systems strengthening activities to be supported under the PEPFAR CI program. Such activities aim to reinforce basic systems, practices and tools that are necessary for optimal institutional performance, improved health outcomes, and sustainable programs.
3. International Research Manager - InterMedia Survey Institute - Washington, USA
InterMedia is seeking an experienced International Research Manager with a verifiable track record of designing and delivering quantitative and qualitative research in developing countries. Candidates will need to have proven experience of effectively managing multi-country research studies and, ideally, will have applied knowledge in the field of financial access and financial services that are available to people at the bottom of the pyramid across the globe ñ often through mobile phones.
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Worth Reading
4. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy
As cited in C-Change C-Channel issue 32, article #2, "[t]he Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published.
....The purpose of this article is to propose a model to help guide future Internet! intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions ....By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established."
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5. Positive Deviance (PD)/Basic Guide to the Positive Deviance (PD) Approach
The Positive Deviance (PD) Initiative is an organization dedicated to the documenting, sharing, and promoting of the "positive deviance approach" to solving social problems. Positive deviance is a behavior and social change approach that views communities as holders of solutions to their own problems. This guide is written to explain the PD approach, which seeks to identify and optimize existing successful solutions or strategies within a community or organization in order to solve problems that require behavior and social change. The PD Initiative provides resources, case studies, and guidance for getting started on their website, as well as a monthly newsletter.
6. Talking About Theory and Practice Blog Entry
This is a blog by Silvio Waisbord, Associate Professor in the School of Media and Public Affairs at George Washington University, Washington, DC, United States. This post raises questions about the dialogue and collaboration between academics and practitioners in development work. Although it recognizes that conversations across institutions do happen, Waisbord thinks that interest is limited because each "community of practice" is driven by different sets of questions. The challenge, then, becomes identifying common issues and avoiding the typical opposition between theory and practice.
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Select Core Resources: Theory and Application
Below you will find a selection of core resources on SBCC theory, models and approaches. A full list can be found in the C-Modules. The core resources are organized into four categories: general, individual, interpersonal, and community/social. The general theories are comprised of several different theories.
Multiple Theories:
7. Theory at a Glance: A Guide for Health Promotion Practice
This is the 2005 edition of a book on behavior change theories, processes, and environmental and common factors that influence behavior as it relates to health. The aim of this guide is to improve the effect of public health workers and to analyze the motives of success or failure of final programs. It presents tools for the resolution of problems in the field of health promotion.
This publication is comprised of: 1) Foundations of Theory in Health Promotion and Health Behavior - includes the "basics" to apply theory to the practice of health promotion, addresses the way in which theory and models can be useful in practice of health promotion and provides basic definitions and the context; and 2) Theories and Applications - begins with the presentation of an ecological perspective of the programs of health promotion and then describes several theories or models of individual and interpersonal behavior. Each theory is presented as a possible method of solving a practical problem. Subsequently, a brief description is presented, as are fundamental definitions of concepts and additional examples or case studies. Finally, 3) Putting Theory and Practice Together - identifies different processes of integration - explains how theories can be used in planning, execution and promotion of health programs.
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8. Family Tree of Theories, Methodologies and Strategies in Development Communication: Convergences and Differences
This paper explores the roots and shape of the field of development communication. In it, Silvio Waisbord presents readers with a "family tree" of theories, concepts, methodologies and strategies for change, describing each "offshoot" of the related but quite distinct directions in which this field has moved - from its origins in post-war international aid programs in developing countries to its various refinements over the years, through to the present day. In short, this report "identifies the main theoretical approaches and their practical applications, traces their origins, draws comparisons, and indicates strengths and weaknesses. It also analyzes the main understandings of development communication that express the outlook of the main 'trunks' and 'branches' of the family tree."
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Focus on the Individual Level:
9. Gender-Specific HIV Prevention with Urban Early-Adolescent Girls: Outcomes of the Keeping' It Safe Program
Published in 2007, this study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls in the United States. The program is based on the AIDS risk reduction model (ARRM), a 3-stage model of harm reduction that integrates concepts from the health belief model, the theory of reasoned action, the theory of planned behavior, self-efficacy theory, emotional influences, and interpersonal processes. According to the ARRM, to avoid HIV infection, individuals engaging in sexual risk behaviors must perceive their actions as problematic (the so-called "labeling" stage), commit to changing the behaviors (the "commitment" stage), and take action to do so (the "action" stage).
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10. The Role of Theory in Developing Effective Health Communications
The purpose of this study was to demonstrate the relevance of behavioral theory for the design of communication to promote healthy behaviors. Using data from a study on smokers' intentions to quit or continue smoking, the authors show how theory helps to identify key beliefs that underlie people's intentions (to quit or not to quit). Final arguments describe the limitations of behavioral theory: While behavioral theory can help identify beliefs that should be targeted with persuasive communication, practitioners' ability to change these beliefs will need support from communication theory to find out how to communicate effectively.
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Focus on the Interpersonal Level:
11. The Relevance of Client-Centered Communication to Family Planning Settings in Developing Countries: Lessons from the Egyptian Experience
From the Abstract: "The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews."
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12. Facilitating Behavior Change with Low-Literacy Patient Education Materials
This 2007 article describes a process for developing low-literacy health education materials that are designed to increase patients' knowledge and motivate them to adopt healthier behaviors. The authors illustrate this process by describing the development of a printed diabetes self-management guide in the United States; however, many of the principles are also applicable to web-based, telephone, and other interactive health education innovations.
As noted here, all health behavior theories consider adequate knowledge of the benefits of healthy behaviors to be a prerequisite for behavior change. Another concept is that of self-efficacy, which in the health care context refers to one's confidence in successfully organizing and executing the courses of action necessary to manage one's health care needs - for example, adhering to a diabetic diet. Furthermore, social cognitive theory suggests that patient education materials designed to activate patients toward healthier behaviors ought to: improve knowledge of the health effects of behavior change; positively influence outcome expectations; emphasize behavior change for facilitators; address impediments to behavior change; and enable the creation and achievement of short-term goals.
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Focus on the Community/Social Level:
13. Culturally Compelling Strategies for Behaviour Change: A Social Ecology Model and Case Study in Malaria
In this paper, the authors "propose a social ecology perspective to make explicit the links between intention to change, actual behavior change, and subsequent health impact, as relating to both theory-based models and practical strategies for triggering change. A social ecology model focuses attention on the contexts of behavior when designing, implementing or critically evaluating interventions. As a case study, the authors reflect on a community-directed intervention in rural Gambia designed to reduce malaria by promoting a relatively simple and low-cost behavior: repairing holes in mosquito bednets. In phase 1, contextual information on bednet usage, transactions and repairs (the "social lives" of nets) was documented. In phase 2 (intervention), songs were composed and posters displayed by community members to encourage repairs, creating a sense of ownership and a compelling medium for the transmission of health messages. In ph! ase 3 (evaluation), qualitative and quantitative data showed that household responses were particularly rapid and extensive, with significant increase in bednet repairs (po0:001), despite considerable constraints on human agency. We highlight a promising approach - using songs - as a vehicle for change, and present a framework to embed the design, implementation and critical evaluation of interventions within the larger context - or social ecology - of behavior practices that are the bedrock of health interventions."
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14. Behavioural Economics: Seven Principles for Policy Makers
From the new economics foundation (nef): This briefing distills concepts from behavioral economics and psychology down to seven key principles intended to highlight the main shortfalls in the neoclassical model of human behavior. The authors aim to change the analytical framework for policy as well as to maximize the impact of policy interventions, as well as reduce unintended outcomes arising from making decisions based solely on a neoclassical economic analysis.
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15. Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory
This working paper, published by the United Nations Children's Fund (UNICEF) Innocenti Research Centre, discusses the application of the social convention theory to the practice of female genital mutilation/ cutting (FGM/C). The theory compares footbinding in China to FGM/C in Africa, explains each practice in terms of simple game theory, and recommends that the methods that were used to end footbinding be adapted to end FGM/C.
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16. What Complexity Science Teaches Us About Social Change
In this article, the traditional frameworks for measurement of social change and development intervention outcomes are questioned. The author, Virginia Lacayo asserts that, "[s]eldom do such methods and indicators reveal the multilevel mechanisms through which social change occurs." Using her work with the Nicaraguan organization Puntos de Encuentro as a case study, Lacayo challenges traditional development planning and research methods based on behavior change communication theories and used by scholars and grantors, resulting in a hegemonic, linear model. She describes her search for a nonlinear, complex, and holistic model that legitimately captures the process of social change in ways that lead to "revamped field-based interventions."
Lacayo looks to complexity literature, which has a framework used to analyze interactions between various actors in systems, such as stock markets, human bodies, forest ecosystems, manufacturing businesses, and hospitals, as complex adaptive systems (CAS). She describes complexity science as seeking to understand how CAS work with regard to the patterns of relationships within them, how they are sustained, how they self-organize and how outcomes emerge.
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17. Explication of Social Norms
The purpose of this article is to explore the intersection between social norms and communication. It does that by distinguishing the different meanings of social norms, addressing the role of moderators between norms and behaviors, and highlighting attributes of behaviors that determine their susceptibility to normative influences. The article distinguishes between perceived and collective norms and between descriptive and injunctive norms.
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Further Reading
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In addition to the above core resources on social and behavior change communication theories, models and approaches, included here are materials for those interested in exploring these topics further. Certain articles may require a membership to the journal to access the full content, but the abstract summaries are available free of charge:
Multiple Theories
Carpenter, C.J. (2010). "Meta-Analysis of the Effectiveness of the Health Belief Model." Health Communication 25.8: 661-669. PMID: 21253982. Jeffery, Robert W (2004). "How Can Health Behavior Theory be Made More Useful for Intervention Research?" International Journal of Behavioral Nutrution and Physical Activity. DOI: 10.1186/1479-5868-1-10. King, Rachel (1999). Sexual Behavioural Change for HIV: Where Have Theories Taken US?. UNAIDS Best Practice Collection.
Rovin, Kimberly, Malea Hoepf, and Karen Hardee (2008). Condoms and CFLs: Environmental Behavior Change Lessons from Public Health. Volume 3, Issue 4. Population Action International.
Focus on the Individual Level
Bandura, Albert (2001). "Social Cognitive Theory of Mass Communication." Media Psychology. 3.3:265-299. DOI: 10.1207/S1532785XMEP0303_03. Bensley, R.J., J.J. Brusk, J.V. Anderson, N. Mercer, J. Rivas, and L.N. Broadbent (2006). Impact of a Stages of Change-Based Internet Nutrition Education Program. J Nutr. Educ Behav. 38.4:222-229. PMID: 16785091. Johnson, B.T., C.A. Redding, R.J. DiClemente, B.S. Mustanski, B. Dodge, P. Sheeran, M.R. Warren, R.S. Zimmerman, W.A. Fisher, M.T. Conner, M.P. Carey, J.D. Fisher, R.D. Stall, M. Fishbein (2010). "A Network-Individual-Resource Model for HIV Prevention." AIDS Behavior 14.2: 204-221. DOI: 10.1007/s10461-010-9803-z.
Focus on the Interpersonal Level
Dainton, Marianne and Elaine D. Zelley (2004). "Explaining Theories of Interpersonal Communication." Communication Theory for Professional Life: A Practical Introduction,Chapter 3.
Focus on the Community/Social Level
Burke, Nancy J., Galen Joseph, Rena J. Patrick, and Judith C. Barker (2009). "Theorizing Social Context: Rethinking Behavioral Theory." Supplement to Health Education & Behavior 36.5:55S-70S. DOI: 10.1177/1090198109335338.
Glouberman, Sholom and Brenda Zimmerman (2002). "Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like?" Commission on the Future of Health Care in Canada. ISBN: 0662327780.
Kelly, J.A. (2004). Popular Opinion Leaders and HIV Prevention Peer Education: Resolving Discrepant Findings, and Implications for the Development of Effective Community Programmes. AIDS Care 16.2:139-150.
Lapinski, Maria Knight and Rajiv N. Rimal (2005). "An Explication of Social Norms."Communication Theory 15:2, May 2005, 127 ñ 147.
Marsh, D.R. and D.G. Schroeder (2002). "The Positive Deviance Approach to Improve Health Outcomes: Experience and Evidence from the Field." Introduction to Good Nutrition Bulletin, 23.4: 5-8. PMID: PMID: 12503225.
Parker, Warren (2004). "Rethinking conceptual approaches to behavior change: The importance of context." Communicating HIV/AIDS Needs.
Ramalingam, Ben and Harry Jones (2008). "Exploring the Science of Complexity: Ideas and Implications for Development and Humanitarian Efforts." Overseas Development Institute. Second Edition. ISBN: 978-0-85003-864-4.
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Training
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18. C-Modules Course on Social and Behaviour Change Communication (SBCC)
Date: Ongoing
Location: Online
C-Change and Ohio University launched the online C-Modules course on social and behavior change communication (SBCC) in two versions - self-paced and facilitated. Available at no cost to participants, the self-paced course is designed for journalists, researchers, students, and government and non-governmental organisation (NGO) health and development practitioners. The goal of the 6-module course is to develop and strengthen competencies in the planning, implementation, and monitoring and evaluation of SBCC activities.
In the self-paced modules, participants work at their own pace to complete units by answering a series of questions, based on the materials and resources provided. Thus, this is a flexible option; individuals can register on their own and are not tied to specific deadlines.
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19. Achieving Millennium Development Goal 5: Reproductive Health, Poverty Reduction and Health System Strengthening
Date: February 27 ñ March 2 2012
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This is really amazing! I am so inspired to listen to this song!
CHRISDANIEL1022
Thank you Kerrie. Phoenix Voyage rises. ABC4All ascends. Quite a pair!
abc4allteam
Its simple to Love and Share!!! Thank you for sharing your heart with the world!
kerrieclaire
We have passed 500 hits bringing the ABC Message where only 3 others out of 44 have more hits! Thanks to all for watching an important message that states the world can be better for all who participate and cooperate!
abc4allteam
Thank you all for sharing this dynamic clip conveying the message of A Better Community For All (ABC4All) - especially the JOYFUL NOISE Choir. Only 3 of 44 messages have more hits thanks to the growing "viral loop of the century!"
abc4allteam
@Kamothoful Thanks for your kind words. Joy for Humanity exists in Uganda! Founded by an ABC4All Mentor there. But what is so inspirational is the way JOYFUL NOISE Choir has made this possible!
abc4allteam 2 weeks ago
Wow what a wonderful inspirational song,Joy to all humanity.
Kamothoful
I on behalf of the Local ABC4ALL {Nigeria} appreciate your hands of friendship, recognizing what the world needs now in what ABC4ALL does, still doing to save lives, what can we ever do successfully without love? we must always know that, our responsibility is to love, and to love is to save.
Love, and then peace to the world to making a better community for all
atomgbe
JOY! JOY! JOY! Yes,"It's Simple just like ABC - A Better Community For All the world to see!" All we have to do is find those in the world receptive and will cooperate. THAT'S IT! Bringing the number of people drinking polluted water from 1.1 billion down to ZERO while matching/doubling all orders/donations for LIFE-SAVING nanotechnology wherever polluted water exists! FOREVER! Not for an hour, a week or even a month. ALWAYS now and FOREVER. That is the Legacy of ABC4All. Here now and forever.