Improving Development Outcomes Through Social and Behavior Change Communication: Applying a Governance Lens

"When community members are listened to and respected and when they feel that they are being responded to, the behavior change adoption is more likely to occur."

(Editor's note: This is a summary of an analytical study that can be found on the United States Agency for International Development (USAID) website at this URL [PDF].) Governmental engagement with citizens on issues that affect their daily lives can be critical for addressing development challenges across sectors. Yet distrust of government and/or the international community and their motives can hamper development efforts. The field of social and behaviour change communication (SBCC) holds lessons for actors seeking to address these challenges. By presenting many of the frequently-used practices from the SBCC field, this study aims to inform and strengthen USAID's work in Africa across sectors such as health, food security, conflict, economic growth, education, and the environment.

Overall, the study found a general preference for community participatory approaches for achieving behaviour change objectives. In SBCC for public health - specifically, in areas such as child health and polio vaccination - the evidence is strong that community participatory approaches lead to better behaviour outcomes. The literature also strongly supports the effectiveness of approaches that engage communities through dialogue-based interventions; these approaches are more likely to reinforce or restore trust in those who represent the state. Trust in these "system actors" - elected/appointed officials, health officials, service providers, etc. - is understood to be critical to achieving behavioural change.

Literature consulted as part of the investigation illuminates the weakness of SBCC approaches that are primarily top-down and unidirectional and that fail to sufficiently include local actors. Several examples offered throughout the report illustrate how such failures can create conditions for disinterest in or even opposition to the intervention. The United Nations Children's Fund (UNICEF), which is a partner in the Global Polio Eradication Initiative (GPEI), published a study in 2001 that explored the implications of neglecting local input into the planning process for National Immunisation Days (NIDs) in Uganda - a country that was still recovering from a long and devastating civil war. The NID process was centralised; as a result, many health workers did not participate in the planning and, thus, had doubts and misgivings and openly campaigned against NIDs. Local leaders were also not included in the social mobilisation strategy. The information vacuum was filled in by anti-vaccination rumours and expanded by radio stations in different parts of the country. In those districts particularly hard hit by rumours, it took investments in the public health system, as well as systematic engagement of local actors and influential local leaders, to regain the trust of community members in the public health system.

As this and other examples provided in the report highlight, SBCC good practices include:

• Promoting a sense of self-efficacy: Placing people at the centre of the planning, implementation, and evaluation of new practices contributes to the development of a sense of collective empowerment that is supportive of a relationship of trust with system actors.
• Leveraging the power of praise: Recognising individuals and communities for adopting new behaviours that lead to positive results can increase overall impact by reinforcing those practices. Community members themselves can praise each other.
• Branding the messages: Consistent use of a unique logo, slogan, and/or musical theme in diverse communication activities helps to reinforce the essential SBCC activities undertaken at the community level and keeps communication partners and other advocates of behaviour change "on message".
• Building upon existing values and social norms: When messages that advocate for broad social and behaviour change draw upon existing social norms and values, it is easier for communities and individuals to trust the message and the messenger and then to adopt new behaviours and practices.
• Capitalising on existing networks: SBCC studies caution against viewing behaviour as essentially individual or as occurring within households analysed as discrete units. Influencing behaviour change within existing social networks often means having trusted insiders within these social networks buy into a proposed behaviour and promote and model it. Such insiders may be early adopters of the proposed behaviours, faith leaders, and/or positive deviants.
• Assuring visibility of government's role in SBCC campaigns with an international dimension: For example, a study of hesitancy to undergo polio vaccination in northern Nigeria indicated that some of the distrust of the vaccination campaign may have stemmed from the fact that national and local public leadership was lacking in the vaccination campaign. The eradication effort became viewed by some as a foreign imposition. More visibility of government officials may be a way of mitigating this type of disenchantment.
• Engaging the private sector: Both small and large businesses have been contributors to the fight against infectious disease, whether they work independently or partner with international organisations, national governments, or non-governmental organisations (NGOs). The literature suggests that, in approaching the private sector, it is important to remind business leaders of the goodwill they can generate with the public by fulfilling their commitment to good corporate citizenship. Business leaders will need to know how their support will be acknowledged during the campaign.
• Deploying schools as vehicles for SBCC: In most African contexts, public schools provide an extensive system of outreach to local people, providing opportunities for people to come together as a community. Numerous health interventions attest to this, including water, sanitation, and hygiene (WASH), HIV/AIDS, and malaria prevention. School systems can also be harnessed for conflict prevention and resolution as well as peacebuilding.
• Learning from the community through formative research: Conducting formative research is standard procedure for informing SBCC activity design. When research is approached from a position of learning from the community about its priorities and concerns, the community feels that it has voice and that government is listening to it. To summarise the process: The researcher listens to community members to identify and build on existing positive behaviours and then identifies existing values, beliefs, and social norms that can often be used to advance the adoption of desired behaviours, and to encourage communities to identify barriers to change and ways to overcome them.
• Promoting community participation in SBCC intervention and service delivery: When system actors work collaboratively or achieve shared leadership with a community, better SBCC results and cost-effective, sustained transformations can result.
• Cultivating local leadership through community-based planning: Community participation in planning and exercising leadership promotes self-efficacy and the confidence to adopt new behaviours. If someone is involved in planning the steps, e.g., a local community leader, the direction tends to be clearer. Programme implementers need to focus on working with these individuals, their social networks, and larger communities in identifying the steps that will lead to the desired results.
• Extending culturally effective formats to the broadcast media: The use of traditional mass media (radio and TV) for the scale-up of behaviour change in Africa has been ubiquitous. The literature shows that the general principles of community participation (using interactive formats such as call-in shows, interviews, and panel discussions) may have greater impact than unidirectional messaging, in part because of the cultural resonance of these interactive formats. Further, the use of dialogue in communication establishes a relationship capable of enhancing trust, particularly if the on-air personalities listen and express empathy and concern.
• Promoting empathetic/effective interpersonal communication: Top-down, unilateral messaging from system actors is often ineffective, and in crisis communication can backfire. Instead, system actors are encouraged to express empathy, concern, and compassion.
• Optimising the use of community-based media: Local radio stations, whether community, religious, or commercial, typically have a strong impact on audiences because community members normally perceive a local station as their own, thus increasing the trust factor and giving credibility to the messages.
• Deploying culturally appropriate communication formats: In African countries, culturally-centred communication approaches include storytelling, puppetry, proverbs, visual art, drama, role play, concerts, gong beating, dirges, songs, drumming, and dancing. As many HIV/AIDS SBCC interventions have demonstrated, the use of such culturally appropriate motifs and methods can enhance the effectiveness of government-led SBCC efforts.
• Using community monitoring of public service provision: In general, active community monitoring/oversight improves the quality of service delivery. Further, it may contribute to improved perception of the state, a heightened sense of self-efficacy, and improved outcomes.

The report stresses that assuring that the above good practices become widely applied will require that basic how-to tools be produced to guide intervention designers and implementers. In addition, training opportunities and transferring of skills (e.g., interpersonal communication skills) skills will contribute to effective adaptation of good practices to diverse programme settings.