An Introduction to BCC/SBC: Social & Behavioral Change Communications

This PowerPoint presentation introduces the concepts of behaviour change communication (BCC) and social and behaviour change (SBC) - unpacking the approach(es) as tools for any programme that wants to change a behaviour or introduce a new behaviour related to, for example, health, the environment, and democracy and human rights.

In simple terms, Richard Pollard defines BCC as "communications designed to trigger an action that will lead to health seeking behaviors". Other terms that may be used in this context are: health education, health communications, health promotion, public advertising, IEC (information, education, and communication), advocacy, social change programming, social marketing, and SBC. BCC/SBC is, in Pollard's estimation, an effort to combine the successful pieces of past experience. To that end, he describes, in turn, each of the broad historic thrusts in which BCC/SBC is grounded, outlining strengths and weaknesses of each: education approaches, persuasion approaches, behavioural modification approaches, social influence approaches, and social marketing.

Pollard explores several lessons learned in implementing BCC/SBC around the world, such as:

• Better understand "environments".
• Rethink "motivators".
• Consider that, what we think is the wrong action we want to change may be perfectly sensible within the environment the audiences live in (so what actually do we want to change?)
• Find/build on existing belief structures.
• Better understand what real needs we are fulfilling; then, create a want for a service.
• Recognise that not all "target" (intended) audiences are the same - there are early adopters, late adopters, drop outs, and so on.
• Always generate an action as a result of communications.
• Build an enabling environment around intended audiences (making the action a social norm).
• Watch out for unintended consequences.
• Deliver an adequate depth and weight of messages to trigger change - both community-based and mass media.
• Identify and find realistic ways to understand and convincingly overcome all relevant resistance/ constraints: social, familial, fears, availability, poor service, cost, priorities.
• Monitor change as it occurs (or not...if no change, what's wrong?) and change with it.

Pollard describes as a best practice the case of using BCC/SBC to address nutrition blindness in Indonesia and Bangladesh. After many years of effort to get pregnant women and young children to consume Vitamin A found in dark green leafy vegetables, fewer than 20% were doing it. Yet, in each country, over 30,000 children were permanently blind because of a lack of vitamin A. BCC/SBC efforts involved looking at existing constraints and motivators (e.g., young children can't digest the veggies; the solution would be to mash them well). However, the success rate was marginal, with only early adopters taking to the change. Questions that needed to be asked: Are there any constraints we don't understand? Are there better ways to overcome existing constraints? Interviews with 200 mothers revealed only a single helpful comment, which revealed that, in one mother's mind, she was being asked to go to a lot of bother to feed a low-value food to solve a low-value health problem. Interviews with still more mothers led to a consensus that it was necessary to rethink motivators - to build the value of vegetables and build a better "why".

Thus, new motivators were needed, and new messages were created accordingly. BCC/SBC practitioners "re-positioned" vegetables and vitamins as essential for strong, healthy children. They also re-positioned the rationale away from blindness (something mothers with no blind children in their village had trouble identifying with) and to general health. To spread the message, they brought in authority figures and a famous singer who is also a mother to add excitement and interest.

Although a lot of information and interest were sparked, there was not enough of a behaviour change. So, 40 more mothers who did not take up the practice were interviewed. The consensus seemed to be: "The singer is just like one of us...what does she know about nutrition? Where did she get this idea from?" In response, a doctor was added to the mix with the famous singer, with the message, "Listen to what this doctor has to say." Compliance shot up, and consumption to desired quantity doubled in one year, at a cost per case of only US$0.25.

In Indonesia, all messages and materials were rolled out nationally, and over 1 million health workers were trained. Mass media were extensively employed. This scale-up gained 25% more users (7.5 million) at a total cost of US$2 million, possibly preventing blindness among 7,500 children.

Lessons learned from this experience include:

• Never assume a motivator, e.g., that the best way to get mothers to feed children vegetables is to instill fears of blindness.
• Never take the majority opinion in qualitative research as the end of the story; any comment may be the key you are looking for.
• Look for and track failure, and adapt.
• Plan so that going to scale is practical and possible.
• Have a communications plan that gains adequate reach and frequency; it may be effective to work with early adopters through mass communications, but late adopters will need community-based encouragement, with mass communications giving this effort credibility.
• Recognise that introducing new ideas must have an enabling environment created around intended audiences.
• Include providers, who need as much behaviour modification as the primary intended audience(s).

Pollard emphasises the value of a systematic process, and several slides depict this - e.g., a matrix for each intervention (each action that the project wants the audience to take).