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	Tools for Behavior Change Communication
January 2008 Issue No. 16	The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org

Home Checklist: Behavior Change Communication Program Cycle Budgeting for Behavior Change Communication Model of an Audience Profile Checklist: Ensuring Good-Quality Materials Checklist: Working With the News Media Types of Evaluation: Purpose, Questions Answered, and Sample Indicators Subscription and Ordering Information Credits Bibliography

CHECKLIST
Behavior Change Communication Program Cycle

How to use this tool: Family planning program managers can use this checklist to help plan, carry out, and evaluate BCC programs. The checklist reflects the communication program processes of several organizations (see list of sources at end of checklist). Each organization’s process has different names for the steps, but they include common elements.

Each step highlights, in a colored box, tips for engaging the participation of members of the intended audience and other key stakeholders.

STEP 1: Analysis

Understand Dynamics of the Health Issue

Determine severity and causes of the health issue, noting differences by audience characteristics such as gender and ethnicity.

Identify possible health-related behaviors that could be encouraged or discouraged.

Identify social, economic, and political factors blocking or facilitating desired behavior changes.

Develop problem statement that summarizes the above points to help identify what aspects of the health issue can be addressed through communication.

Understand Audience and Other Potential Participants in the Program (Formative Research)

Identify primary audience (people who are at risk of or are suffering from the health problem) and secondary audiences (people who influence health behaviors of primary audience).

• Collect in-depth information about the audience: What are their knowledge, attitudes, and beliefs about health? What factors affect their health behaviors? What are their media habits? What access do they have to information, services, and other resources? Where do they currently stand in the stages of behavior change?
• Are there different groups of people who have similar needs, preferences, and characteristics (audience segments)? Will the BCC program need customized messages and materials to suit audience segments?
• Develop a profile, or description, of each audience segment to help the creative team develop effective messages and materials later (see Checklist: Ensuring Good-Quality Materials).

Conduct participant analysis.

• What other people or groups can participate in the BCC program (partners, stakeholders, allies, and gatekeepers)? These may include nongovernmental organizations, professional associations, schools, faith-based groups, and the media. What skills or resources can they off er? What would motivate their participation?

Conduct channel analysis.

• What communication channels are available?
• What are the strengths and weaknesses of each channel? For example, how effective are the channels in reaching the audience? How many people can they reach?

Engage community participation Be open and public about the program’s objectives. Respond to the audience’s expressed needs. Involve audience members and other key stakeholders in the analysis of their own concerns. Participatory techniques include scoring and preference ranking (community members weigh different problems or program options as to how well they meet various criteria) and community mapping and modeling. In this process community members draw a map of their community to identify what programs are available and where they may be needed most.

STEP 2 : Strategic Design

Define communication, behavior change, and program objectives.

• Communication objectives describe desired changes in indirect influences on behavior, such as knowledge, attitudes, and social norms. Behavior change objectives refer to intended changes in the audience’s actual behavior. Together, communication and behavior change objectives contribute to the overall program objective, which refers to anticipated results of the overarching health program.
• Are objectives SMART: specific, Measurable, Appropriate, Realistic, and Timebound? (see companion Population Reports, p. 12)

Develop a conceptual framework to show how program activities are expected to contribute to objectives.

Use the conceptual framework to help select monitoring and evaluation indicators.

• Are indicators valid—that is, do they measure the topic or issue that they are meant to reflect? Are indicators reliable—that is, do they produce consistent results when repeated over time? Are they specific (measure a single topic or issue), sensitive (responsive to change), and operational (measurable)?

Prioritize communication channels.

• Use relevant behavioral theories and findings from formative research to guide the choice of channels.
• To help maximize effect, can the program use a mix of the three major types of channels—mass media, interpersonal, and/or community channels?

Develop a creative brief to share with people and organizations involved in developing messages and materials.

• Does the brief include a profile of the intended audience, behavior change objectives, resulting benefits that the audience will appreciate, channels that will carry the messages, and the key message points?

Draw up an implementation plan, including activities, partners’ roles and responsibilities, timeline, budget, and management plan.

Develop a monitoring and evaluation plan.

Engage community participation Select participants who work with or represent those most directly affected by the health issue; ensure fair representation of women and marginalized groups. Facilitate their involvement in strategic design workshops by using appropriate exercises and “games.” Hold workshops at locations in the community at times that are convenient for them.

STEP 3 : Development and Pretesting

Develop messages and materials.

• Use findings from formative research and the strategic plan to guide development. The creative brief and audience profiles developed in Step 2 summarize this information.
• Tailor messages to the audience’s stage of behavior change.
• Choose type of appeal, such as empowering or entertaining, and tone, such as humorous or authoritative.

Pretest messages and materials with audience members.

Revise messages and materials based on pretesters’ reactions.

Engage community participation Form an advisory group made up of key stakeholders close to or representing the audience. Advisory groups can provide useful advice about developing appropriate messages and materials and can help with revisions after pretesting. Invite audience members to suggest messages and materials.

STEP 4 : Implementation and Monitoring

Develop and implement a dissemination plan.

Manage and monitor program progress—activities, staffing, budget, and responses of the audience and other stakeholders.

Make midcourse adjustments to the program based on monitoring results.

Engage community participation Mobilize a large number of stakeholders to help implement activities and develop a broad sense of ownership. Offer different means and levels of participation during implementation. For example, for a radio program, audience members can participate in listening groups, suggest questions for the program, or even start a community radio program. Include audience members and other stakeholders in steering committees to oversee program implementation, make recommendations, and ensure action to improve activities.

STEP 5 : Evaluation

Measure outcomes, assess impact.

Disseminate results to partners, key stakeholders, the news media, and funding agencies.

Record lessons learned and archive research findings for use in future programs.

Revise or redesign program based on evaluation findings.

Engage community participation Involve audience members in evaluating the program against parameters they set themselves (participatory evaluation). Ask what they want to know and why, how they can help conduct the evaluation, and how they will use the results. Encourage involvement of audience members in experimental evaluations (designed to measure outcomes objectively). Share key findings of the experimental evaluation with audience members and of the participatory evaluation with other stakeholders. Encourage participants from the audience to share evaluation findings with their communities, advocate further activities, and spread activities to other communities.

Sources: Cabañero-Verzosa 2003 (3), Figueroa et al. 2002 (6), GreenCOM 2004 (8), Health Communication Partnership 2003 (9), National Cancer Institute 2001 (13), O’Sullivan et al. 2003 (14), Synergy Project 2006 (18), Tapia, Brasington, and Van Lith 2007 (19), U.S. CDC 2006 (21), UNICEF and WHO 2000 (24), and WHO 2003 (25)

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