SBCC Theory

Behavior change theories help us understand why people act the way they do and why behaviors change. SBCC theories can be helpful to guide decisions about what audiences and behavioral determinants to focus on. Each theory or model explains behavioral change in a slightly different way but many share common premises. When designing SBCC strategies, we often draw from more than one behavior change theory to come up with an explanatory theoretical model.

Not Sure Which Theory to Use?

Readers can go to either the Resources section for further information on specific theories or use TheoryPicker, an interactive tool that helps you identify what might be the best behavior change theory for a given program. The tool takes you through a number of steps and asks you questions to help determine which is the best theory or group of theories to use for your program design.

The design of your campaign will depend on a number of country-specific factors, such as the type of SSFFC medicine problem (i.e., substandard vs. falsified vs. degraded vs. diverted), your medicine supply chain and regulation systems, the possible prevention and reporting solutions available in your country, and the factors that support or create barriers to performing those behaviors. To walk through the process of determining your SSFFC problem and the campaign that works best for you, proceed to Promoting Quality Medicines.

Before you start developing your strategy, you should ask yourself the following questions:

• Does the selected method of communicating the dangers of SSFFC malaria medicines undermine confidence in ACTs? As with any effective SBCC strategy/program, we need to convince our audience that they will benefit in some way from adopting the recommended behavior. With SSFFC malaria medicines, one major benefit of changing treatment and vending practices is that the medicine an individual buys or sells will be good quality, and therefore able to treat malaria. Depending on how we communicate this benefit, we could create the impression that malaria medicines are useless, and discourage people from using them.

  The global community has been working for some time to encourage ACT use. Now, because of this hard work, many consumers already believe that the medicines that they are taking are effective. If we warn them to beware of SSFFC medicines, we could discourage them about the quality of the healthcare system and ACTs. This could cause them to stop taking ACTs all together. It is important that we do not backtrack on the gains made in treatment seeking behavior with our messages about SSFFC malaria medicines. An alternative approach may be to emphasize the importance of ensuring that the medicines they use are good quality. This is a subtle, but important difference in the way a message is framed. It will also be very important to gauge audience reactions to your messages through pretesting. More about the pretesting of messages can be found in this section.

• Advocacy or SBCC? Depending on the strategy’s vision and problem statement, practitioners will need to decide whether advocacy or SBCC is the priority. Advocacy and SBCC have different objectives: advocacy aims to change or introduce policies and laws or to mobilize resources; SBCC aims to change behavior and norms. Often, a combined advocacy and SBCC strategy will be called for. For example, in Nigeria, stakeholders attributed the use of SSFFC malaria medicines to consumer and vendor beliefs and practices as well as weaknesses in the medicine supply system. The strategy, therefore, employs SBCC to address consumer and vendor practices, and advocacy to leverage improvements in the supply system.

• Integrated or Vertical Messaging? If local stakeholders are already implementing SBCC activities for malaria case management, it may be cost effective to integrate messages about SSFFC medicines into your ongoing malaria messaging. The main advantage of this is that it may be less expensive, quicker to execute and be seen as coming from a trusted source. On the other hand, messages about SSFFC medicines will not get as much attention with target audiences when they are combined with other information. One solution might be to begin with intensive vertical media messaging to introduce the issue for a short period of time, followed by messaging integrated with other case management communication over the long term.

• Can the same SBCC strategy work in other countries and communities? The simple answer to this question is that not all countries have the same problems and potential solutions to SSFFC ACTs and monotherapies. Thus, it is important to design a communication strategy that speaks to the specific problems and possible solutions revealed in your situation analysis.

  Sound and effective SBCC strategies are designed to address barriers to optimal health behaviors or practices, and to encourage the uptake of specific practices. In the case of substandard or falsified malaria medicines, barriers to the use of good quality medicines, and the protective actions available to consumers, medicine dispensers and regulatory agencies, vary from country to country. Barriers may have to do with weak or non-existent regulatory policies, inadequate enforcement of existing laws and policies, unlicensed drug markets or sellers, inaccessible and/or expensive medicines, and consumer treatment seeking and drug purchasing practices. Protective actions may include mobile solutions, like NAFDAC of Nigeria’s Mobile Authentication Service (MAS), which lets consumers verify the quality of their medicines using their mobile phones. They may also include messaging that asks customers to buy from higher quality medicine sources, or check the batch number and expiration date of medicine before they buy. Other options that may exist in country can be found in the Promoting Quality Medicines section, such as: free telephone numbers that medicine distributors and consumers can call to check the authenticity of medicines or report substandard medicines; quality assurance and surveillance systems; training and licensing medicine vendors; enforcing drug importation, or manufacturing and distribution laws and regulations. The role of SBCC programs will vary according to the situation.