Designing an SBCC Intervention for CHW Behavior Change

Step 6: Define Your Strategic Approach

At this stage, it is important to make decisions about which broad communication approach is most appropriate to achieve your communication objectives. In doing so, it is critical to consider both the needs and preferences of your intended audience and how well various approaches will work with your specific objectives and barriers and in your current context. An SBCC strategy may include more than one approach.


To determine which type of approach is the most appropriate, it is important to first answer a set of key questions:

  • Which motivational barrier or barriers are you trying to address? Perceived Status, Incentives and Personal Rewards, Level of Connectedness, Social and Gender Norms, Personal Attitudes and Beliefs or others.
  • How complex is the barrier? Complex barriers like social norms and attitudes are better addressed with approaches that allow for dialogue.
  • How sensitive are the issues to be addressed? Issues that the audience may not want to discuss publicly or that they feel may compromise their compensation, promotion opportunities or standing among peers require approaches that are more confidential and one-on-one.
  • What is the level of literacy and/or technical comfort among the intended audience? Community radio and group discussions which require less reading and/or more active engagement may be more appropriate for those with lower reading and educational levels.
  • What is the desired reach? How large is the intended audience segment and how wide is the geographic location in which they work? Some approaches are limited in reach but allow for greater depth in coverage of a particular issue.
  • What are the cost considerations? What is known about cost per person reached and the known cost effectiveness of a particular approach? Does this fit within the available budget?
  • What is the level of acceptability of approach for the intended audience? The format should be appropriate for the intended audience in terms of what they are used to and comfortable using. For example, some CHWs may be resistant to support supervision, peer support and more interactive coaching styles, particularly if supervisors are younger or the intended audience is more comfortable with a hierarchical management style.
  • What is the level of technology and innovation and is it appropriate for the intended audience? Lower level, less educated or even older CHWs may be more resistant to new technological methods like tablets, smart phones and formats that use social media or mobile health technologies or they may not have access to these types of tools.

Communication Approaches to Be Considered

The table below does not include every possible approach, but it describes some communication approaches that have been used successfully in programs to improve CHW performance. See the SBCC Strategy I-Kit for more examples of strategic approaches.

ApproachDefinitionBarriers AddressedSBCC Examples for CHWs
AdvocacyA deliberate process, based on evidence, to directly and indirectly influence decision-makers, stakeholders and relevant audiences to support and implement actions that contribute to health and human rights.

  • Policy
  • Resource allocation
  • Legal changes
  • Perceived status
  • Connectedness to health facilities
  • Social and gender norms

Using evidence informed communication targeting leaders at Ministry of Health to allocate resources enabling CHWs to receive a small stipend, reward or recognition as incentive for good performance.
BrandingProcess of developing a symbol, logo and design that distinguishes one product, service or idea from the competition.

  • Incentives and rewards
  • Perceived status
  • Social support
  • Peer connectedness
  • Connectedness to community

Developing a mark or symbol and making it visible on trained CHWs' clothing, bags and homes, etc., to identify them as high-quality service providers.
Mobile HealthA tool to expand access to health information and services using mobile and wireless technologies such as mobile phones, tablets and mobile software applications.

  • Ability barriers
  • Perceived status
  • Connectedness to peers
  • Connectedness to the health system
  • Connectedness to supervisor
  • Incentives and rewards

Sharing short videos through Bluetooth technology to demonstrate better IMCI counseling practices among select CHW members who own smart phones or feature phones.
Role ModelingProcess of strategically engaging people whose behavior or success can be emulated by others to influence behavior change.

  • Social status
  • Incentives and rewards
  • Social and gender norms

Identifying high-performing, well-liked CHWs and partnering them with new or demotivated CHWs for scheduled "work- alongs."
Satisfied ClientAn intervention which enlists individuals who have successfully adopted a select behavior, service or product to conduct outreach with individuals who are non users/non-adopters.

  • Connectedness to community

Select and engage young mothers who recently received high-quality community-based counseling and who are also willing to speak out in local radio talk shows or community activities to encourage local families’ support of CHWs.
Support Supervision and CoachingA feedback approach that promotes mentorship, joint problem-solving and communication between supervisors and their staff.

  • Connectedness to supervisor

A supervisor may apply interpersonal communication techniques during routine monitoring to jointly identify behavioral and performance goals, techniques to address individual barriers and coach CHWs on ways to improve performance.

Identify several communication approaches you would like to use by answering the questions above. Use the following table to analyze any potential approaches you are considering. For each audience and each communication objective, write the approach and evaluate it against the selection criteria.

Key Approach Intended Audience Communication Objective
Criteria Meets this Criteria (Y/N)
1. Matches the identified motivational barrier.
2. Is appropriate for the level of complexity of the barrier.
3. Is appropriate for the level of sensitivity of the barrier.
4. Matches audience literacy level.
5. Meets reach requirements for audience.
6. Is within program budget.
7. Is an acceptable approach to the intended audience.
8. Technology and innovation level is appropriate.

Download Key Approach Table

Selecting Communication Channels

Once you determine your broad approach, the next step is to select specific communication channels. Channels are the specific set of communication tools you want to use. Generally, channels can be organized into four main categories: interpersonal, community based, mass media and social media. The following table defines the different channels and provides examples of how these channels may be applied in CHW programs.

Channel Types Definition Examples
Interpersonal: Counseling, peer to peer, client-provider and supervisor to CHW  The process by which two or more small groups of providers exchange information and ideas through face-to-face interaction.

  • Site visits with leaders and politicians to advocate for policy change
  • Coalition building meetings for improved connectedness to communities
  • CHW peer meetings to improve connectedness to peers
  • Support supervision visits, team meetings to improve connectedness to supervisors

Community Based: Community dialogue, community drama, community radio and community events A process that engages and motivates a wide range of partners and allies at national and local levels to raise awareness of and demand for a particular objective through dialogue.

  • Community dialogues to develop selection criteria for CHWs
  • Community events to recognize high-quality CHWs

Mass Media: Radio and TV; serial dramas, game shows, websites, newspaper, magazines and posters Diversified media technologies that are intended to reach large audiences via mass communication including radio, film, and television.

  • Radio soap opera modeling effective CHW/client interaction
  • Radio talk shows with CHWs on air as guests to build links to community
  • Newspaper articles recognizing successful CHWs

Social Media: Facebook, WhatsApp, SMS, blogs and podcasts Internet services where the online content is generated by users of the services including blogging, social network sites and Wikis, etc.

  • Facebook page for CHWs
  • Motivational videos shared on WhatsApp among CHWs
  • Blog for CHWs
  • Social media user group among CHWs to enable their sharing of better practices, learnings and new techniques related to their work

Refer to the resources section below for detailed guidance on how to select the best channel.

Once the most appropriate communication approach is determined, work with a creative team to develop messages and materials.

Don’t forget to ensure that these materials are pre-tested with your primary CHW audience before being finalized and produced!

Record your selected communication approach(es) and communication channels in the Step 6 section of the SBCC Strategy Template.


Resources for Materials’ Development:




Social Media

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Step 5: Determine the Key Promise and Support Points (Prev Step)
(Next Step) Step 7: Match Communication Approach to Identified Motivation Barrier
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