Developing Programs, Campaigns & Products for

Behavioural Impact

Robyn DrysdalePrevention Adviser

SPC Public Health Programme

Training ObjectivesTraining ObjectivesBy the end of the workshop, participants will• understand how individuals and communities change

and how health-related change occurs• have developed skills in developing their own programs

which facilitate behavioural change• understand the key elements of behaviour change

communication• have identified risk behaviours, attitudes and key

health issues in local communities• have improved skills in developing programs,

campaigns and products targeting specific groups• have improved skills in monitoring and evaluation of

BCC materials

Expectations:Expectations:

By the end of this workshop….

• What do you want to What do you want to know (understand)know (understand)??

• What What skills skills do you want to have? (be able to do you want to have? (be able to dodo))

• How do you want toHow do you want to feel? feel?

Where are you at?Where are you at?Firstly: Why do a pre-test & post-test?

Workshop pre-test

Identified only by a number (please remember your number!)

Results put together (pre & post test) & presented back to you on the final day

Morning Tea breakMorning Tea break

REMINDERREMINDER•Please hand in your pre-Please hand in your pre-

tests!tests!

What does this mean to me?

• Key points for you

• Implications for your work, your program

Understanding behaviour change

• How individuals change • Behaviour change models• Stages of change• Creating a supportive environment• Building community capacity

(ability) to support positive behaviour change

Programs to promote behaviour change are often based on the following assumption:

Parnell & Benton (1999)

Any problems with Any problems with this?this?

Behaviour change is hard!• Many health and community workers believe

that people change their behaviour easily and quickly eg. that young people will act differently after reading a pamphlet about the risks of smoking or unprotected sex.

• This is not the case, because long-term behaviour change is much more complicated than this

Factors impacting behaviour change

Behaviour

Environment Popular Support

Endorsement by leaders Benefits

CulturePast experience

What is needed then?• Before people and communities can reduce their

risk to a particular health issue they must first:– understand the basic factsbasic facts about the health

issue– believebelieve that they and others in the community

are at riskat risk– learn about how tohow to reduce their risk– have access to products access to products and and servicesservices that

will help them – believe that others in their community community

supportsupport change and keeping up safe/ health seeking behaviour (including accessing treatment, care & support)

Activity: Activity: Personal change storyPersonal change story

• In pairs each person describes “one positive change that happened in your life in the past 3-5 years”

• Repeat (other person)

• Report back to group: 1 min each

Understanding Behaviour Change Communication

(BCC) • Behaviour change communication, or BCC,

is a way of helping people to make positive, long-lasting changes to habits and behaviour (eg. using condoms for safe sex or taking up regular exercise to get fit)

• Helping people to make these changes is not always easy, happens in stages and can take a long time.

Stages of ChangeStages of Change• This a model often used to influence behaviour

change called the Stages of Change. • The model focuses on a number of logical steps

which motivate and support behaviour change.

Steps in Stages of Change

1. Not thinking about it (Pre-knowledge)

2. Thinking about it (Knowledge)

3. Making a decision (Approval & Intention)

4. Acting on the decision (Practice)

5. Sticking with it/ maintenance (& Advocacy)

Stages of Change

Or Or ‘‘HIC-DARMHIC-DARM’’

First, we H ear about the new behaviour

then, we become I nformed about it

and later C onvinced that it is worthwhile

In time, D ecision to do something about we make the our conviction

and later we take A ction on the new behaviour

we wait for next R e-confirmation that our action was a good one & if all is well, we M aintain the behaviour

Motivating factorsMotivating factors

• In the same pairs you told the stories in, ask each other

“What motivated you for your change?” (what made you want to make the change)

• Record 2 or 3 words to summarise these motivating factors

The enabling The enabling environmentenvironment

Activity/ discussion – Growing Taro!

• How does taro grow?

• What is required in the environment to enable the taro to grow?

• What in the environment can be a barrier to the growing of taro?

The Enabling EnvironmentThe Enabling Environment• The “stages of change” model is useful in

explaining how behaviour change can be achieved and maintained. But no behaviour happens in isolation.

• People respond to what’s happening around them, and to their own motivations and needs. They then choose to behave accordingly.

• Many influences around a person can help or get in the way of change.

• A range of influential features in the environment must be in place to enable a person to change.

• The key factors that influence positive change can be grouped together & called the environment for behaviour change or enabling environment

No behaviour happens in No behaviour happens in isolation!isolation!

Influential Features

• Behaviour change can sometimes be helped, sometimes made difficult, by influential features of a particular environment.

• Features of the environment can assist change through providing encouragement or through making sure the availability of necessary resources.

Each setting, or ‘environment’ has a range of influential features including:

• social• cultural• ethical and spiritual• legal• political• resources

• Features of an environment that help change for some people might be barriers to change for others.

Enabling changeEnabling change

• Review the personal change story of last session in pairs: “What made the change possible (enabled the change) in your story?”

• List on your own note paper 3 things that made the change possible (in language of choice).

Developing a supportive environment

what is needed in Northern Marianas to develop a supportive environment to reduce the risk of health problems (or to promote health)?

What sort of things/ services/ programs? Who would be involved?

Daily evaluation:Daily evaluation:What shape are u in?What shape are u in?

In 4’s: What from today surprised you?

In 3’s: What is something you would like to learn more about?

In 2’s: Anything you would like to tell the facilitator/ organisers?

Day 2 Day 2

Hafa Hafa adai!adai!

Understanding behaviour change

How individuals change Behaviour change modelsStages of changeCreating a supportive environment• Building community capacity

(ability) to support positive behaviour change

Capacity DevelopmentCapacity Development• You may need to “build capacity” or

empower people to support them to change their behaviour

• All communities have ways of sorting out problems

• You can support your community by building on people’s past experiences, skills and knowledge, and helping them see things in a different way

• ‘Capacity development’ is about developing and strengthening the ability of individuals, families, communities and nations to respond to issues that concern them.

Capacity development Capacity development && behaviour changebehaviour change

• If people in your community work together, they can help each other to come up with solutions to health problems. It is important to work together.

• Community participation and ownership is important for people to take on new behaviours. The community has to welcome the changes as their own and not feel these are being forced on them by an outsider.

• The capacity to achieve change cannot be imposed or taught. It must come from within each community and country.

BEHAVIOUR CHANGE SUMMARYBEHAVIOUR CHANGE SUMMARY

In summary, changing behaviour is brought about by communicating the right message, through the right mediums, to the right audience, together with building people’s skills to change, and creating a supportive creating a supportive environmentenvironment within which this can all take place.

What kinds of programs best

help to facilitate behaviour change?

The role of programs in The role of programs in facilitating behavioural facilitating behavioural

changechange• Behaviour change is different for every person, and

does not occur in one step. People move through stages of change in their own ways and in their own time.

• The enabling environment influences people’s process through the stages of change.

• People adapt and improve the enabling environment through individual and collective capacity development.

• The main goal for any behavior change program is to increase people’s capacity to make changes to their environment so that it makes movement through the stages of change possible.

Current preventative Current preventative health programs in health programs in Northern MarianasNorthern Marianas

It is important to find out

1. What programs are there in CNMI – who, what & which target group?

2. what is working and should be continued or expanded?

3. what is not working and needs a new approach?

4. what has not been addressed at all (gaps)?

Pre-Workshop Assessment: Messages &

Materials Brief Review• Where are community members (your

target audience) getting messages/ materials on your health issue?

• Were they effective? (How did people react to them?)

• What do you recommend about these materials/ messages

Involving the audience in project planning

• It is important to involve your audience and people who are directly affected by the issue in the project.

• If a plan is in place to provide training and support (capacity building), the audience can be involved at every level of your community health project.

• Involving them in your activities will not only strengthen your project, it will also help to create a supportive environment where disease/ illness-related stigma and discrimination are reduced, and where people feel more comfortable to talk openly about the health issue.

Day 2 EvaluationDay 2 Evaluation

In small groups (5-6 per group), explain to each other:

• What happened today?• How did it happen?• What are the results?