Behavior change (public health)
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Behavior change has become a central objective of public health interventions, with an increased focus on prevention in health services at many levels. This is seen as particularly important in low and middle income countries, where the efficiency of health spending and the costs and benefits of health interventions has been under increased scrutiny in recent decades
Many health conditions are caused by risk behaviors, such as problem drinking, substance use, smoking, reckless driving, overeating, or unprotected sexual intercourse. The key question in health behavior research is how to predict and modify the adoption and maintenance of health behaviors. Fortunately, human beings have, in principle, control over their conduct. Health-compromising behaviors can be eliminated by self-regulatory efforts, and health-enhancing behaviors can be adopted instead, such as physical exercise, weight control, preventive nutrition, dental hygiene, condom use, or accident prevention. Health behavior change refers to the motivational, volitional, and actional processes of abandoning such health-compromising behaviors in favor of adopting and maintaining health-enhancing behaviors.
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. 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 behavioral change theories which gained ground in the 1980s. These theories share a major commonality in defining individual actions as the locus of change. Behavior change programs that are usually focused 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," "The Health Belief Model" and the Health Action Process Approach.
Behavior Change Tools
- Care groups are groups of 10-15 volunteer, community-based health educators who regularly meet together.
- Barrier Analysis is a rapid assessment tool used in behavior change projects to identify behavioral determinants.
- Community-led total sanitation is a behaviour change tool used in the sanitation sector for mainly rural settings in developing countries with the aim to stop open defecation. The method uses shame, disgust and to some extent peer pressure which leads to the "spontaneous" construction and long-term use of toilets after an initial triggering process has taken place.
Behavior Change Communication
Behavior Change Communication, or BCC, is an approach to behavior change focused on communication. The assumptions is 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. BCC 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, etc.
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One criticism is that its practitioners have on several occasions developed new terms to describe their approach (e.g. Strategic Behavioral Communication (SBC); Information, Education, Communication (IEC); and Communication for Social Change (CSC).) This suggests that BCC is an evolving area, rather than a mature field. Other criticisms are that behavior change encompasses conflicting approaches, insufficient impact measurement, variety of theories, and overly mechanistic approaches. Theories emerging from the West reflect change ideologies rooted in rational choice, individual transformations, and the role of reason and knowledge. Practices emerging in developing countries illustrate the role of the community, social acceptance, emotion, and emulation in personal change.
For example, villagers in a Kenyan community offered this theory of behavior: experiences trigger emotions, positive or negative, which in turn shape attitudes that lead to behavioral choices. One person's behavior can become another person's experience. 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, they may be able to demonstrate transformational power of BCC.
- WHO 2002: World Health Report 2002 - Reducing Risks, Promoting Healthy Life Accessed Feb 2015 http://www.who.int/whr/2002/en/whr02_en.pdf?ua=1
- US Center for Disease Control and Prevention National Prevention Strategy Accessed Feb 2015 http://www.cdc.gov/features/preventionstrategy/
- Jamison DT, Breman JG, Measham AR, et al., (eds) (2006) Disease Control Priorities in Developing Countries. 2nd edition Chapter 2: Intervention Cost-Effectiveness Accessed Feb 2015 http://www.ncbi.nlm.nih.gov/books/NBK11784/
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU∙CCP) specializes in health-related BCC programs, primarily in developing countries. It includes programs in reproductive health and family planning, tuberculosis, malaria, clean water and sanitation, and HIV/AIDS.
- Private Sector Partnerships USAID project focused on increasing the private sector's role in providing high-quality health products and services in developing countries.
- Sara Del Valle: Effects of Behavioral Changes in a Smallpox Attack Model An article demonstrating the impact of behavioral changes on disease spread.
- Research on the psychology of online behavior change campaigns: Online Interventions for Social Marketing Health Behavior Change Campaigns
- Barrier Analysis resources: Barrier Analysis website, Barrier Analysis narrated presentation, Barrier Analysis Facilitator Manual
- Designing for Behavior Change Curriculum was developed by the CORE Group Social and Behavior Change Working Group
- Delivering on Your Good Intentions: The Foundations of Habit-Based Behavioral Change - a 2013 paper looking at how habits affect behavior change efforts. Paper was developed for 2Morrow, Inc and focuses on Health & Wellness.