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Behaviour Change for
Providing What is Behaviour Change? B ehaviour change is referred to any transformation or modification of human behaviour. The term has been used widely in the public health domain as behaviour has implications on a wide array of health outcomes. It is therefore critical for the prevention, management and treatment of many important health conditions.Behaviour change is a very complex and individualistic process and varies from individual to individual. Therefore before designing any intervention, there is a need to understand the values, standards, norms, attitudes and knowledge that govern change in behaviour. The process of behaviour change requires intensive research to develop an effective intervention and communication strategy that goes beyond delivery of a simple message or slogan to encompass the full range of ways in which people individually and collectively convey meaning. There are many theories that explain behaviour change and one of the most accepted theory is called Trans theoretical Model of Change. According to the Trans theoretical Model, which is also known as the Stages of Change Model, behaviour change is a five-step process. The five stages, between which individuals may oscillate before achieving complete change are precontemplation, contemplation, preparation for action, action, maintenance and relapse. At the precontemplation stage, an individual may or may not be aware of a problem and has not thought of changing his / her behaviour. From precontemplation to contemplation, the individual begins thinking about changing a certain behaviour. During preparation, the individual begins his / her plans for change and during the action stage, the individual begins to exhibit new behaviour consistently. An individual finally enters the maintenance stage once he / she exhibits the new behaviour consistently for over six months. A problem faced with the Stages of Change Model is that it is very easy for a person to enter the maintenance stage and then fall back into the earlier stages. Factors that contribute to the relapse include external factors such as weather or seasonal changes and/or personal issues a person is dealing with. Defining Behaviour Change Communication (BCC) Behaviour change communication (BCC) is the strategic use of communication to promote positive health outcomes, based on proven theories and models of behaviour change. BCC employs a system aticprocess beginning with formative research and behaviour analysis followed by tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community and societal behaviour change; and maintain appropriate behaviours. BCC programmes include a wide range of interventions that fall into three broad categories: • Mass media (radio, television, billboards, print material, internet and social media)• Interpersonal communication (group presentations and door to door interactions)• Community mobilisation.Another crucial component of behaviour change communication is to provide a supportive environment which will enable people to initiate and sustain positive behaviours. Why Behaviour Change is Required to Achieve Adequate and Equitable Water for All? Each year,1.8 million people die from diarrhoeal diseases (including cholera); 90% of whom are children under five years in developing countries. 1 It is estimated that 88% of these deaths could be prevented by safe water supply, sanitation and hygiene.2 Massive resources have been invested in providing access to water in the last two decades but still there are many gaps. Access to safe water as measured currently indicates only access to an improved source and does not necessarily reflect gaps in the total eco-system aspects of the water supply/delivery i.e. quality, reliability and sustainability. These gaps in the eco-system result in increased health and economic burden.To realise the full potential of the resources, the ‘hardware’ component’* needs to be combined with behaviour change programmes especially in developing countries. People’s behaviour needs to be influenced to provide adequate water to all. Behaviour change campaign should motivate people to adopt water treatment technologies, safe storage methods and maintain hygienic conditions to avoid re-contamination of water. To influence all of these, there is a need to design targeted behaviour change interventions. Current Policy Scenario Current policies for behaviour change have got a lot of attention in the last few years. As the government realises that only providing citizens with water will not solve the problem of waterborne diseases and that there are other factors which need to be taken care of, behaviour change is now being recognised as a crucial intervention. According to the Constitution of India, water is a state subject. Under the 74th Constitutional Amendment, responsibility of water supply in rural areas has been provided to Panchayati Raj Institutions and in urban areas to the Urban Local Bodies (ULBs). Both these entities have funds for Information Education and Communication (IEC) allotted from two central level ministries i.e. the Ministry of Drinking Water and Sanitation responsible for rural water supply and sanitation and the Ministry of Urban Development responsible for urban water supply and sanitation. These IEC funds allotted by the government are for initiating change in behaviour. The central government has provided the IEC guidelines to the states. In the absence of mechanisms to ensure effective implementation on the ground, most states are not able to utilise the allotted IEC funds. It is normally during the annual monsoon season that the governments use the IEC budget to create awareness about water borne diseases. To address the situation in rural areas, states have been creating another institution called Water and Sanitation Support Organisation (WSSO) since 2009 for all the ‘software’ activities*. WSSO is intended to be part of the State Water and Sanitation Mission (SWSM) in each state. At the state level, most of the IEC activities will be taken up by these WSSOs. Another major gap in the current policy scenario is development of relevant and influencing IEC material. Each state develop its own IEC material in the relevant dialect so that people can understand and relate to it. But there is no understanding of which IEC material is working well and which is not. The current communication strategies and IEC material do not hit an individual hard enough so that they start thinking on the issues concerned. This results in a lot of efforts getting wasted. Policy Recommendations • Designing of the IEC material should not just be a design room activity. There is a need to come up with hard hitting and provoking messages so that they influence people to think in the desired direction. It is important to understand the target community’s values, habits and norms to design effective IEC material.• In behavioural science, there is no ‘one fit solution for all’. Thus, systems need to be put in place to understand the effectiveness of IEC. It is also important to understand the effectiveness of the developed IEC material among the target audience on a regular basis.• To realise the vision of safe water to all, a multi-sector effort is required with strong involvement of many departments and ministries, including women and child development, public information, health and education departments. The IEC money from all these different heads should be used to reach the target audience through different mediums for creating a larger, more effective impact.• The recently launched Swachh Bharat Mission has a major focus on sanitation as majority of our Indian population still practice open defecation. As part of the IEC activity in rural and urban India, focus should be given on water handling, hygiene practices and water treatment so that we can solve the problem of waterborne diseases as a whole and not in small parts. qKavneet Kaur References: http://planningcommission.nic.in/plans/planrel/fiveyr/11th/11_v2/11v2_ch5.pdf http://www.mdws.gov.in/iec http://www.mdws.gov.in/sites/upload_files/ddws/files/pdf/IEC%20guidelines%20PDF.pdf http://www.mdws.gov.in/sites/upload_files/ddws/files/pdf/IECKRCTNAnote.pdf http://www.mdws.gov.in/documentreports/term/44 http://moud.gov.in/ Endnotes
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