Behavior change (public health)

Behavior change has become a central objective of public health interventions over the last half decade, as the influence of prevention within the health services has increased. The increased influence of prevention has coincided with increased multi-lateral and bi-lateral aid in the area of human development, and the increased need for the international development community to show cost-effectiveness for allocated dollars spent.

Behavior change programs, which have evolved over time, encompass a broad range of activities and approaches, which focus on the individual, community, and environmental influences on behavior. The term Behavior Change Communication (BCC) specifically refers to community health seeking behavior, and was first employed in HIV and TB prevention projects. More recently, its ambit has grown to encompass any communication activity whose goal is to help individuals and communities select and practice behavior that will positively impact their health, such as immunization, cervical cancer check up, employing single-use syringes, and so on.

Behavior change, a relatively recent public health related term, should not be confused with behavior modification, a term with specific meaning in a clinical psychiatry setting.

Behavior change programs tend to focus on a few theories which gained ground in 1980s. These theories share a major commonality in defining individual actions as the locus of change. Behavior change programs usually focus on activities that help a person or a community to reflect upon their risk behaviors and change them to reduce their risk and vulnerability are known as interventions. See also 'The Transtheoretical (Stages of Change) Model of Behavior Change', 'The Theory of Reasoned Action', and 'The Health Belief Model'.

It is one of the characteristics of Behavior Change Communication, or BCC that its practitioners keep coining new terms to describe their approach — recent ones include Strategic Behavioral Communication (SBC); Information, Education, Communication (IEC); and Communication for Social Change (CSC). True, some of these terms are more about behavior and change than others, but all do share the belief that through communication of some kind, individuals and communities can somehow be persuaded to behave in ways that will make their lives safer and healthier.

The shifting terminology, a characteristic of this field, is a pointer to the fact that BCC is an evolving area, rather than a coherent topic. It is neither a discipline, nor a science or an art. It encompasses conflicting approaches, too little measurement of impact, a variety of theories, and approaches that some feel are too mechanistic. Theories emerging from the West reflect change ideologies rooted in rational choice, individual transformations, and the role of reason and knowledge. BCC practices emerging in developing countries illustrate the role of the community, social acceptance, emotion, and emulation in personal change.

Villagers in a Kenyan community, for example, offered this theory of behavior when asked: the experiences a person undergoes trigger emotions, positive or negative. These shape attitudes, which lead to behavioral choices. One person’s behavior becomes another person’s experience, and the cycle begins again.

This simple, home-grown theory has much wisdom. It suggests that if a person’s experience is the key to his or her behavior, then one way to stimulate new behavior might be to expand this pool of experience. NGOs in Kenya, such as PATH, have designed ways to bring about experience-sharing through deep dialogue in groups and theater processes. In India, participatory community-driven theater among sex workers led to passionate and heartfelt dialogue. In many cases, the critical reflection triggered by these discourses has led participants to self-driven behavior changes.

One school of thought argues that BCC that focuses on “target” audiences and fixed, externally determined behavioral outcomes can violate the very principles that underlie work in the community: dignity, participation, and choice. Focusing on community involvement can lead to deep and durable changes. If BCC practitioners can support communities in understanding their risks, and helping them design behavior change solutions that will work for them, perhaps we will begin to understand where the true transformational power of BCC lies.