Designing a Social and Behavior Change Communication Strategy

Now that the communication objectives have been determined, two tasks will help describe how the SBCC program will meet these objectives This “how” will be the strategic approaches used to achieve the communication objectives. Typically, a communication strategy will include several approaches, especially if addressing multiple audiences across the social ecological levels. The approaches chosen drive the SBCC program and help ensure consistency and coordination among partners and synergy across program interventions.

The strategic approaches can be incorporated into a goal-oriented campaign. Campaigns include a combination of approaches (usually including mass media in addition to community-based approaches) and provide multiple opportunities for exposure through a consistent theme that links program activities together. A campaign provides benefits to the individual and/or society, typically within a given time period, by means of organized communication activities .

Strategic approaches are often depicted through a strategic framework, which shows how activities will contribute to objectives. The process for developing a strategic framework is described in Task 2.

What You Need to Know to Get Started

Strategic Approaches

• Advocacy
  Advocacy operates at the political, social and individual levels and works to mobilize resources and political and social commitment for social change and/or policy change. Resources can include political will and leadership as well as money to fund the implementation of policies or programs. Advocacy aims to create an enabling environment at any level, including the community level (i.e. traditional government or local religious endorsement), to ask for greater resources, encourage allocating resources equitably and remove barriers to policy implementation. Guidelines for advocacy as a process are provided in the ASK Approach.
• Community-Based Media
  Community-based media reach communities through locally-established outlets. Such outlets include local radio stations and community newsletters/newspapers as well as activities such as rallies, public meetings, folk dramas and sporting events.
• Community Mobilization
  Community mobilization is a capacity-building process through which community individuals, groups or organizations plan, carry out and evaluate activities on a participatory and sustained basis to improve their lives, either on their own initiative or stimulated by others. A successful community mobilization effort  not only works to solve problems at the community-level but also aims to increase the capacity of a community to successfully identify and address its own needs.
• Counseling
  Counseling is based on one-to-one communication and is often done with a trusted and influential communicator such as a counselor, teacher or health provider. Counseling tools or job aids are usually also produced to help clients and counselors improve their interactions, with service providers trained to use the tools and aids.
• Distance Learning
  Distance learning provides a learning platform that does not require attendance at a specific location. Rather, the students access the course content either through a radio or via the internet and interact with their teacher and fellow classmates through letters, telephone calls, SMS texts, chat rooms or Internet sites. Distance learning courses can focus on training communication specialists, community mobilizers, health educators and service providers. (See Information and Communication Technology for examples on eLearning.)
• Information and Communication Technology (ICT)
  ICT is the fastest growing and evolving approach, with an increasing reach throughout the world. This approach includes digital media such as web sites, e-mails, listservs, Internet news feeds, chat rooms, virtual learning and eLearning, eToolkits and message boards. Digital media is unique in being able to disseminate highly tailored messages to the intended audience while also receiving feedback from them and encouraging real-time conversations, combining mass communication and interpersonal interaction . Interactive digital media providing such tailored health information can be effective in helping people manage diseases, access health services, and obtain social support or provide assistance in changing behaviors. Through such media, the audience can generate and share information and ideas. Social media is a sub-set of digital media, and examples include Facebook, Twitter, Linked In, blogs, eForums, and chat rooms. Additional information on eLearning can be found at Global Health eLearning Center and PEPFAR eLearning Initiative. More information on eToolkits can be found at K4Health’s eToolkits Technical Brief.

  mHealth: mHealth Fact Sheet and mHealth Toolkit.

  ICT: Utilizing ICT in Demand Generation for Reproductive, Maternal, Newborn & Child Health: Three Case Studies and Recommendations for Future Programming. For a guide on developing mobile health communication strategies, refer to mBCC Field Guide: A Resource for Developing Mobile Behavior Change Communication Programs.

• Interpersonal Communication (IPC)/Peer Communication
  Interpersonal and peer communication are based on one-to-one communication. This could be parent-child communication, peer-to-peer communication or communication with a community leader or religious leader. For more information, see When to Use IPC.
• Mass Media
  Mass media can reach large audiences  cost-effectively through the formats of radio, television and newspapers. According to a review, mass media campaigns that follow the principles of effective campaign design and are well-executed can have small to moderate effect size not only on health knowledge, beliefs, and attitudes, but on behaviors as well. Given the wide reach of mass media and the potential to reach thousands of people, a small to moderate effect size will have a greater impact on public health than would an approach that has a large effect size but only reaches a small number of people. Thus mass media can have a major public health impact  given its wide reach.
• Social Mobilization
  Social mobilization brings relevant sectors such as organizations, policy makers, networks and communities together to raise awareness, empower individuals and groups for action, and work towards creating an enabling environment and effecting positive behavior and/or social change.
• Support Media/Mid-Media
  Mid-media’s reach is less than that of mass media and includes posters, brochures and billboards.

Task 1: Identify Strategic Approaches

Process: Facilitated discussion

Tools: Choosing Strategic Approaches

Output: Strategic approaches finalized

The strategic approaches describe how the objectives will be achieved. They will guide the development and implementation of activities and will determine the vehicles, tools and media mix that your team will use. Within each approach, you will have multiple vehicles, use various tools and rely on a mix of approaches to communicate to your audience(s). The approaches will convey your messages, be mutually reinforcing and be the routes of message delivery.

• Refer to findings from formative research and information gathered during Step 1 to help determine the most appropriate approaches. The context of the situation can help determine opportunities for possible approaches as well as limitations to what can or cannot be used.
• Determine which approaches will best reach intended audience(s):
  • What would the intended audience find most appealing?
  • What will best influence the intended audience?
  • What would be most effective in motivating change? Who does the intended audience trust?
  • What would be most credible?
  • What will best reach the intended audience?
  • What will achieve the greatest impact?
  • What times are best for the audience?
    • If mass media or social media will be used, when is the audience most likely to tune in? (watching TV, listening to the radio, accessing the internet, logging into on-line social networks)
  • If community-based approaches will be used, when is the intended audience available? Are there already established community-events on which you can piggy-back activities?
• Consider the types of messages which will be used:
  • Which approaches are the most appropriate for conveying these messages?
  • If skills need to be modeled, can the approaches effectively model and demonstrate specific behaviors?
• Refer to the table “Choosing Strategic Approaches” as well as A Theory-Based Framework for Media Selection in Demand Generation Programs for additional considerations when determining approaches.
• Combine multiple approaches to help increase reach and increase repetition of the messages. This will increase exposure and further reinforce the messages being delivered.
  • What mix of approaches will reach a large proportion of the audience efficiently and effectively (and still fit within your budget)?

Choosing Strategic Approaches

Considerations	Appropriate Approaches
Complexity of the Challenge	Face-to-face communication allows for dialogue and discussion with your audience. Mass media can model complex behaviors. Social media can encourage discussions about the challenge, through e-mails, text messages, chat rooms, or voice mails. If your audience can read, written materials allow the audience to refer back to them as often as they would like.
Sensitivity of the Challenge	Interpersonal approaches and one-on-one communication work well when discussing sensitive topics.
Effectiveness of Approach to Address Challenge	An approach may be more or less effective depending on the challenge being addressed. For example, a a recent synthesis of meta-analyses s on the effectiveness of health communication interventions found entertainment education formats to be well suited for motivational messages and moving social norms, face-to-face counseling seems to help people learn about and adhere to more effective strategies to quit smoking, and media campaigns were better than interpersonal interventions without media for HIV/STD prevention.
Literacy	If audience is not literate, an approach which does not rely on the written word will be more effective.
Desired Reach	Mass media, most internet-based interventions, and many mHealth interventions have an advantage in their potential reach and can provide regional and national coverage. Such approaches can deliver messages to scale.
Cost	Consider the cost – and the cost effectiveness (in terms of cost per person reached) of the various approaches and determine how best to use your budgeted funds. Tools which help calculate the value for money and quantify the impact of approaches can be found at http://www.nsmcentre.org.uk/resources/vfm
Innovation	Consider using approaches that are new and fresh for your audience. Using an approach that is unexpected can make it more appealing and interesting to your audience.
Youth	Consider age or generation because some mobile-based or social media approaches may appeal more to young adults.

Useful Resources

Health COMpass: An interactive and collaborative resource for high quality Tools and Project Examples to build capacity in social and behavior change communication.

K4Health Toolkits: Toolkits provide quick and easy access to relevant and reliable health information in one convenient location, intended for health program managers, policy makers and service providers.

Advance Family Planning Advocacy Portfolio: A compendium of best practices and tools in advocacy for family planning.

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Identifying Strategic Approaches Example

Tanzania's COMMIT project and Ghana's BCS project are among the examples of identifying strategic approaches.

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Task 2: Create Strategic Framework

Process: Facilitated discussion or a separate activity after the strategy workshop/working group, as needed

Output: Strategic Framework developed

A strategic framework is a visual representation of how program activities are expected to achieve the objectives. The framework outlines the change process with information on the context of the challenge, the domains to be addressed, and the expected outcomes. The Pathways^© framework is a good example of a strategic framework for SBCC programs. The Pathways^© framework:

• Presents the cross-cutting nature of communication
• Illustrates the complexity of social or behavior change, outlining the individual, social, environmental, and political factors that can affect change
• Illustrates how communication occurs within three domains:
  • Within the social political environment
  • At the health service delivery level
  • Among individuals and communities
  • Individual factors may include social support/stigma, emotional engagement, beliefs, attitudes, norms and values, perceived risk, self-efficacy, health literacy and recall of messages. These individual factors then interact with other factors  at the social, environmental, or political levels, including access to resources, the level of community support, the quality of services, and the nature of the policy environment.

While the Pathways is generally read from left to right and thus suggests causal order and progression toward change, it does not mean to suggest that change is a strictly linear process ^[11] . It can also be adapted to better fit program needs and could be developed, for example, to be read from top to bottom.

• Develop a strategic framework that outlines the change process, context, domains, and expected outcomes.
  

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Creating a Strategic Framework

Check out how Malawi's SSDI project and Egypt's CHL project created their strategic frameworks.

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