BEHAVIOUR CHANGE AND COMMUNICATION - a descriptive literature review of behavior change and communication in Sub-Saharan countries Susanna Kauppi Thesis, Fall 2015 Diaconia University of Applied Sciences Master's Degree in Global Health Care Master of Social and health care ABSTRACT Susanna Kauppi. Behavior change and communication. Descriptive literature review. Diaconia University of Applied Sciences.
Master’s Degree in Global Health Care. Degree: Master of Health Care. Activities for promoting health among any population are a formidable task. Especially in the developing countries societies might face challenges to respond to the requirements of the better health.
Population growth, low economy, poor infrastructure and health system and sometimes unstable political atmosphere are affecting individuals' and communities’ health. However, the great majority of the diseases are preventable and human behavior plays a central role in the prevention of disease and in the maintenance of health even though change in behavior takes often considerable time and results might be seen after years. By understanding behavior and barriers of behavior change as well as used communication channels and methods it is possible to plan and implement activities which have better health outcomes. This study is a descriptive literature review.
The purpose of this literature review is to describe factors which associate behavior and behavior change in the communities and to describe communication and communication methods which have been used in behavior change communication programs in developing countries of Sub-Saharan Africa. The objective of the study is to provide information about health behavior communication in community and used methods which can be utilized in behavior change campaign in developing countries. The study followed the process of descriptive literature review. After the identification of the research question, data were collected from the scientific databases, Academic Search Premier and ProQuest, and manually from the other sources between February and August 2015.
39 researches were accepted to this review, most of them were published in 2009 or after and conducted by the quantitative method. Data were analyzed by the descriptive synthesis. The synthesis produced seven main themes which contained factors related behavior and behavior change and communication. Communal and personal issues, culture, education and knowledge, economy and access to goods are related to behavior and behavior change as well as way of communication.
The above mentioned issues, both individual and community are interwoven to each other and therefore behavior change need to be seen in wider context. Community’s influence on behavior is stronger in comparison with the individual’s own capability to behavior change and therefore the involvement of the community from the beginning is a key issue for the success of behavior change campaigns. Various media channels can be used to deliver the message of behavior change and combination of many communication methods such as mass media and personal communication predicts better outcome. Behavior change is not an exact science and each person and community behaves as they do due to different reasons.
Even though there are a lot of researches about behavior change, further research is needed. More information is needed about the interventions of behavior change and their outcomes. Due to technological development all over the world, more information is needed how new technology with application programs can be utilized in behavior change campaigns. Keywords: behavior change, individual, community, communication, Sub-Sahara CONTENT 1 INTRODUCTION 4 2 BEHAVIOR CHANGE 7 2.1 Theories of behavior change 10 2.1 Social cognitive theory 11 2.2 Social ecological model 11 2.3 Diffusion of innovation theory 12 2.2 Behavior change communication 13 2.3 Community 15 3 PURPOSE, OBJECTIVE AND RESEARCH QUESTIONS OF THE STUDY 17 4 METHODOLOGY AND RESEARCH PROCESS 18 4.2 Analysis of the research material 24 5 RESULTS 28 5.
Factors relate to behavior change 28 5.3 Culture and tradition 33 5.4 Education and knowledge 35 5.6 Accessibility of goods 39 5.2 Communication and communication methods of behavior change 40 6 DISCUSSION 45 6.1 Inspection of the results 45 6.2 Reliability, limitation and ethics of the research 50 6.4 Suggestions for future research 53 REFERENCES 54 APPENDIX 1: FINAL SEARCH FROM THE DATABASES 64 APPENDIX 2: RESEARCHES INCLUDED IN THE REVIEW 65 1 INTRODUCTION According to WHO (2009) inequalities in health are rooted in inequities in society. However, health is a fundamental human right and a social investment, which is affected by political, economic, social, cultural, environmental, behavioral and biological factors. Governments’ duty is to create healthy public policy and health promotion which are covering all their citizens. Policies and health promotion need to be adapted to the local needs and possibilities taken into account differing social, cultural and economic systems.
In the developing countries, good health and wellbeing are not the norms for most of the people. Lack of resources, weak public health infrastructure and unresponsive governance has all great impact on welfare of poor people. Inadequacy of health facilities means that poor people suffer from diseases without being able to communicate their needs. (Macfarlane, Racelis & Muli-Musimee 2000.) Moreover, preventive health and remedial care could be under-invested or over-invested by the households if people do not have information about illness prevention, neither the effectiveness or cost-effectiveness of preventative behavior (Dupas 2011).
The purpose of health promotion is to influence the health behavior of individuals and communities on the positive way. Health promotion improves the health status of individuals, communities and the nation and improves the quality of life for all people.) Most of the health problems are preventable and the solution lies in behavior change (Newson et al. Previous approaches to behavior change focused on individual. However, individual’s behavior is linked to social determinants, environment and norms in society.
These factors have been seen to have stronger effect on behavior change than the individual’s own personal capacity and hence health promotion, education and behavior change should focus on the social and environmental determinants of health rather than individual's behavior. (Ragnarsson et al.) Behavior change theories help program to understand why people behave as they do and how the change is possible to achieve. Theories help to evaluate the behavior change process. However, theories have not been used as required because application of theory to practice might be found difficult due to lack of clear guidelines.
Lack of information 5 about theories as well as lack of information about technics which should be used let program planners and leaders to avoid behavior change theories (Corcoran 2013; Webb, Sniehotta & Michie 2013.) Moreover, many theories have focus on individual’s behavior forgetting environment and social relations and their effects on behavior (Corcoran 2013). Experience has showed that people are able to solve their own health related issues and other concerns in partnership with governments and non-governmental organizations (Macfarlane et al. Community participation is essential on each stage of health promotion actions (Atkinson, Vallely, Fitzgerald, Whittaker & Tanner 2011; Babalola et al. 2006), because it also predicts better success for the program (Riehman et al.
In summary, health promotion is done with community members, by community members and for community members (Ritchie 2007, refer to source Green & Tones, 2010). Behavior change is influenced by many factors. Readiness for behavior change is highly influenced by the attitude and personal values of the individual. Moreover, behavior is influenced by the prevailing culture and environment (Green & Tones 2010) as well as people they liked and who have authority (Newson et al.
Households might learn from their neighbors and peers and learning from the others happens faster than learning by oneself. Education and access to information as well as economic balance of the household often promote behavior change.) Poor access to service and goods as well as poor experience of the previous campaigns impairs behavior change (Corcoran 2013). Health and development programs use behavior change communication to improve people’s health and well-being. According to Dupas (2011) information can make a difference, but not all kind of information.
The source of information has to be credible, traceable (Tindana et al. 2011) and culturally acceptable (Atkinson et al. A successful program has a clear goal and focus narrowly on specific behavior (Kirby, Laris & Lori 2007). Target group for the information and information campaigns has to be selected well and sometimes it is necessary to cover a larger population if the campaign has direct or indirect effects on people around (Tindana et al.
Effective communication uses various channels (Ricotta et al. 2015; Atkinson et al. 2011; Briscoe & Aboud 2012; Kirby et al. 2007; Babalola et al.
2006) such as mass media and 6 interpersonal communication (Sood, Shefner-Rogers & Skinner 2014). Message has to be repeated frequently (Atkinson et al. People need to have enough time to adapt to the new information and message has to be presented in a simple manner (Newson et al. Especially individuals with low education might not be able to process complex information, but on the other hand more educated people might have a skeptic attitude towards simple information (Dupas 2011).
Behavior change communication and behavior change in the communities have produced plenty of researches in the developed and developing countries. Characteristic of the subject is much culture bonded and therefore factors which influence behavior cannot be generalized worldwide even though similarities might exist between cultures. Therefore, more research is needed to investigate which kind of factors are influencing behavior in certain area. Moreover, more information is needed about used communication methods, because of technological development.
The purpose of this literature review is to describe factors which associate behavior and behavior change in the communities and to describe communication and communication methods which have been used in behavior change communication programs in developing countries of Sub-Saharan Africa. The objective of the study is to provide information about health behavior communication in community and used methods which can be utilized in behavior change campaign in developing countries. 7 2 BEHAVIOR CHANGE Behavior change has become a central objective of public health and health promotion interventions, as the influence of prevention within the health services has increased. According to Newson et al.
(2013) “behavior change is often positioned as a required individual adaption for avoiding or reducing the risk of ill-health.” However health transition is influenced by upstream determinants, thus behavior change for better health is needed at all levels: individual, family, community, country and the world (Newson et al. At individual level, beliefs, behaviors and biology affect the balance between health and disease. Social and economic priorities, culture, access to health-promoting environments as well as health services are key determinants of health at the level of families and communities. National and global level has a downstream impact on the health of families and individuals when the speed of development and the distribution of developmental benefits and supplies across social groups act as drivers of health transition.
(Newson et al.) Culture can have strong impact on the behavior of the individual and therefore health programs should make attempts to develop culturally appropriate strategies. Culture reflects in a group’s meaning of life, practices and norms. Language and the way of communication are part of the culture as well as ethnicity. (Corcoran 2013; Huff & Kline 1999.) Culture shapes how personal understanding of health and illness are constructed ( Airhihenbuwa, Ford & Iwelunmor 2014).
Cultural differences can present major barriers to effective interventions and therefore awareness and sensitivity to cultural diversity has to be taken into account in planning, designing and implementation of health promotion program. Especially western style communication with a quick snapshot may be seen cold and too direct in other cultures.) Poverty and poor education influence behavior change in developing countries. Poverty limits access to interventions and poor education is a barrier to information. Poverty and poor infrastructure in the society influences the adoption of behavior change if the access to interventions is not possible due poor roads or other constrains such as lack of electricity.) 8 The threat and fear of health risk can motivate people to seek information.
However, fear can also cause people to deny that they are at risk.