Behaviour Change Communication
- The Need for Action Research

Introduction

How does behaviour change occur? How is behaviour change sustained? These questions probably have as many answers as there are diverse populations and cultures. The underlying principles may not be formally recognized as theories, but they focus behaviour change efforts on the elements believed to be essential for individuals to enact and sustain behaviour change.

Three of the most commonly cited theories literature are outlined in this article: The Belief Model, the Stages of Change, and the Theory of Reasoned Action. This is then juxtaposed against the theory of community participation. The role of dialogue processes in behaviour change communication is then highlighted concluding with a need for further action research in this arena.

Belief Model (BM)

The Belief Model (BM) is a psychological model that attempts to explain and predict behaviours by focusing on the attitudes and beliefs of individuals. The BM was developed in the 1950s as part of an effort by social psychologists in the United States. Since then, the BM has been adapted to explore a variety of long- and short-term health behaviours.
The key variables of the BM are as follows (Rosenstock, Strecher and Becker, 1994):

• Perceived Threat: Consists of two parts: perceived susceptibility and perceived severity of a condition.

• Perceived Susceptibility: One’s subjective perception of the risk of being in a debilitating condition,

• Perceived Severity: Feelings concerning the seriousness of being in a debilitating condition (e.g., poverty)

• Perceived Benefits: The believed effectiveness of strategies designed to reduce the threats.

• Perceived Barriers: The potential negative consequences that may result from taking particular actions, including physical, psychological, and financial demands.

• Cues to Action: Events, either bodily (e.g., physical symptoms of a health condition) or environmental (e.g., media publicity) that motivate people to take action. Cues to action are an aspect of the BM that has not been systematically studied.

• Other Variables: Diverse demographic, socio-psychological, and structural variables that affect an individual’s perceptions and thus indirectly influence related behaviour.

• Self-Efficacy: The belief in being able to successfully execute the behaviour required to produce the desired outcomes. (This concept was introduced by social psychologist Albert Bandura in 1977.)

Limitations

Most BM-based research to date has incorporated only selected components of the BM, thereby not testing the usefulness of the model as a whole;

As a psychological model it does not take into consideration other factors, such as environmental or economic factors, that may influence health behaviours; and the model does not incorporate the influence of social norms and peer influences on people’s decisions regarding their health behaviours

Stages of Change

Psychologists developed the Stages of Change Theory in 1982 to compare smokers in therapy and self-changers along a behaviour change continuum. The rationale behind “staging” people, as such, was to tailor therapy to a person’s needs at his/her particular point in the change process. As a result, the four original components of the Stages of Change Theory (pre-contemplation, contemplation, action, and maintenance) were identified and presented as a linear process of change. Since then, a fifth stage (relapse) has been incorporated into the theory that helps predict and motivate individual movement across stages. In addition, the stages are no longer considered to be linear; rather, they are components of a cyclical process that varies for each individual. The stages, as described by Prochaska, DiClemente and Norcross (1992), are listed below.

• Pre-contemplation: Individual has the problem (whether he/she recognizes it or not) and has no intention of changing.

• Contemplation: Individual recognizes the problem and is seriously thinking about changing.

• Preparation for Action: Individual recognizes that there is a problem and intends to change the behaviour within a specific time period (e.g. the next month). Some behaviour change efforts may be reported. However, the defined behaviour change criterion has not been reached.

• Action: Individual has enacted consistent behaviour change for less than a relatively long period of time (e.g. six months).

• Maintenance: Individual maintains new behaviour for prolonged periods of time (e.g. more than six months).

• Relapse: Individual repeats the original behavioural pattern after a period of ‘Maintenance’

Limitations:

As a psychological theory, the stages of change focuses on the individual without assessing the role those structural and environmental issues may have on a person’s ability to enact behaviour change. In addition, since the stages of change presents a descriptive rather than a causative explanation of behaviour, the relationship between stages is not always clear. Finally, each of the stages may not be suitable for characterizing every population.

Theory of Reasoned Action (TRA)

Research using the Theory of Reasoned Action (TRA) has explained and predicted a variety of human behaviours since 1967. Based on the premise that humans are rational and that the behaviours being explored are under volitional control, the theory provides a construct that links individual beliefs, attitudes, intentions, and behaviour (Fishbein, Middlestadt and Hitchcock, 1994). The theory variables and their definitions, as described by Fishbein et al. (1994), is as follows - A specific behaviour is defined by a combination of four components: action, target, context, and time.

• Intention: The intent to perform behaviour is the best predictor that a desired behaviour will actually occur. Both attitude and norms, described below, influence one’s intention to perform behaviours.

• Attitude: A person’s positive or negative feelings toward performing the defined behaviour.

• Behavioural Beliefs: Behavioural beliefs are a combination of a person’s beliefs regarding the outcomes of a defined behaviour and the person’s evaluation of potential outcomes. These beliefs will differ from population to population.

• Norms: A person’s perception of other people’s opinions regarding the defined behaviour.

• Normative Beliefs: Normative beliefs are a combination of a person’s beliefs regarding other people’s views of behaviour and the person’s willingness to conform to those views. As with behavioural beliefs, normative beliefs regarding other people’s opinions and the evaluation of those opinions will vary from population to population.

The TRA provides a framework for linking each of the above variables together. Essentially, the behavioural and normative beliefs – referred to as cognitive structures - influence individual attitudes and subjective norms, respectively. In turn, attitudes and norms shape a person’s intention to perform behaviour. Finally, a person’s intention remains the best indicator that the desired behaviour will occur.

Overall, the TRA model supports a linear process in which changes in an individual’s behavioural and normative beliefs will ultimately affect the individual’s actual behaviour. The attitude and norm variables, and their underlying cognitive structures, often exert different degrees of influence over a person’s intention.

To date, behaviours explored using the TRA include smoking, drinking, signing up for treatment programmes, using contraceptives, dieting, wearing seatbelts or safety helmets, exercising regularly, voting, and breastfeeding (Fishbein et al., 1994).

Limitations:

Some limitations of the TRA include the inability of the theory, due to its individualistic approach, to consider the role of environmental and structural issues and the linearity of the theory components. Individuals may first change their behaviour and then their beliefs/attitudes about it. For example, studies on the impact of seatbelt laws in the United States revealed that people often changed their negative attitudes about the use of seatbelts as they grew accustomed to the new behaviour.

Overall

Overall, the merging of components from various theories is common, as researchers and programmers seek to gain a better understanding of how behaviour change occurs.

The current integrated theoretical discourse follows the linear process that outlines an increase in information or knowledge leads to change in attitudes which in turn lead to behaviour change.

The study of behaviour change communication has been limited to the field of health and sanitation till so far. However, civil society organizations such as DA has been attempting to change the behaviour of people along various other parameters including climate change adaptation and mitigation, agriculture, livelihoods, enterprise development, etc.

In this context it becomes imperative to contextualize the theories involved in behaviour change to both the local context and the specific behavioural targets.

Community Participation

The discussion about the sustainability of any behaviour change has been positively co-related to the degree of community participation. Community participation involves a power-sharing relationship between communities and decision-makers.

There are varying degrees of power available to the community. Arnstein (1971) describes a ladder of degrees of citizen participation, providing a framework to aid consideration of how to involve the public.

It is no hidden fact that the agenda of behaviour change is often driven by external factors. The most specific being a funding organisation. The civil society organisation involved in grassroots level work, driven by donor agenda, attempts to enforce specific behavioural targets on the community with minimal participation from the community members.

It is in this context that the concept of dialogue becomes prominent. However, given that much of the theory of Behaviour Change Communication is derived from therapeutic work with individual clients, it poses a logical conflict on at least two levels.

1. Applicability of the theories to large scale grassroots

2. Degree of participation involved

Suggestions

In the light of these dilemmas, Behaviour Change Communication while used as a strategy for grassroots level developmental work incorporates two major activities. The first of these activities is identifying key people in the community who are willing and able to induce the desired changes among people in the community and building their capacities to influence other people’s behaviour. This can be achieved by doing training programmes in various counselling, governance and participatory tools.

The second and more prolonged activity is supportive supervision so that the trained volunteers/animators are able to see fruition of their work through the continuous consultation with experts.

Both these activities address to some extent, how large scale behaviour change can be influenced as well as raises the participation from mere behaviour manipulation to change in behaviour based on1 mutual consultation.

Such strategies have been adopted and proven in the sector of health in India within Bundelkhand.

Conclusion

In conclusion, it can be stated that the theories of behaviour change and behaviour change communication are very individualistic and prescriptive. Further action research is required to systematize Behaviour Change Communication specifically to technological innovations and addressing climate change issues by influencing adaptation and mitigation practices at the grassroots.

Sudeep Jacob Joseph
sjjoseph@devalt.org

References
• Bandura, A. (1989). In V. M. Mayes, G. W. Albee and S.F. Schneider (Eds.), Behaviour Change: Psychological Approaches (pp. 128-141). London: Sage Publications.

• Rosenstock, I.M., Strecher, V. J., & Becker, M. H. (1994). The belief model and HIV risk behaviour change. In R.J. DiClemente & J. L. Peterson (Eds.), Preventing AIDS: Thories and Methods of Behavioural Interventions (pp.5-24). New York: Plenum Press.

• Brown, L. K., DiClemente, R.J., and Reynolds, L. A. (1991). HIV prevention for adolescents: Utility of the Health Belief Model. AIDS Education and Prevention, 3 (1), 50-59

• Fishbein, M., Middlestadt, S.E., and Hitchcock, P. J. (1994). Changing Health Behaviours. In R.J. DiClemente and J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioural interventions (pp. 61-78). New York: Plenum Press.

• http://www.healthknowledge.org .uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/consumerism-community-participation q

 

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