This document can be found at http://www.crc.uri.edu/.

For more information contact:

Coastal Resources Center

University of Rhode Island
Narragansett Bay Campus
South Ferry Road
Narragansett, Rhode Island 02882, USA
Tel: (401) 874-6224
Fax: (401) 874-6920
Email: balanced@crc.uri.edu

Any part of this Guide may be photocopied or adapted without permission

from the BALANCED Project, provided that the parts copied are distributed
for free and duly recognize the BALANCED Project.

Citation: Bruce, Linda. 2013. Developing Behavior Change

Communication Interventions for Population, Health and Environment
Projects: Facilitator Guide. University of Rhode Island. Narragansett, RI.

Disclaimer: This publication is made possible by the generous support of

the American people through the United States Agency for International
Development (USAID). The contents are the responsibility of the Coastal
Resources Center, University of Rhode Island as part of the Building Actors
and Leaders for Advancing Community Excellence in Development
(BALANCED) Project and do not necessarily reflect the views of the
United States Government. Cooperative Agreement No. GPO-A-00-08-
00002-00.

Cover Photo (top) Pangani FM radio spot on behavior change communication,

Tanzania
Photo Credit: Woodrow Wilson Center

Cover Photo (bottom): Peer educator using information, education and

communication messages during community drama in Pangani, Tanzania
Photo Credit: Juma Dyegula
 Acknowledgements

We thank Dr. Enrique Hernandez from PATH Foundation Philippines, Inc. for his invaluable
input during the behavior change communication workshops, which helped inform this
curriculum.

We would also like to give special recognition to the partners of the Health of People and
Environment in the Lake Victoria Basin (HOPE-LVB) Project for allowing us to test the
methodology in this document as they developed their behavior change communication
strategy and integrated communication messages. Special thanks as well go to the United
States Agency for International Development’s PHE Advisor, Matt Erdman, for his valuable
support and input to this Guide.

i
ii
 FOREWORD

Developing Behavior Change Communication Interventions for Population, Health and

Environment Projects: Facilitator Guide was developed by the Building Actors and Leaders for
Advancing Community Excellence in Development (BALANCED) Project with support from the
United States Agency for International Development (USAID).

The BALANCED Project is a five-year, multi-million dollar population, health and environment
(PHE) technical leadership initiative awarded by the USAID Office of Population and
Reproductive Health. The Project, which is implemented by the University of Rhode Island’s
Coastal Resources Center (URI/CRC) and its partners—PATH Foundation Philippines Inc.
(PFPI) and Conservation International (CI)— promotes wider adoption and use of effective
PHE approaches worldwide by:

• Enabling local communities to become PHE champions by building their capacity to

plan, implement and carry out demand-driven integrated programs in health and
conservation. BALANCED builds capacity through peer-to-peer mentoring, south-to-
south exchanges, and innovative learning techniques.

• Synthesizing and developing state-of-the art PHE knowledge and communicating that
knowledge to key audiences. This includes demonstrating the value of integrated
approaches for development that take into consideration the environment and the
people who live in it.

• Scaling-up, building on, and fostering the implementation of field-based PHE initiatives
in areas of high biodiversity, particularly in East Africa and Asia.

This Facilitator Guide draws on basic behavior change communication (BCC) principles used
by key non-governmental organizations implementing health projects and the BALANCED
Project’s experience developing, and assisting other organizations to develop BCC
interventions for PHE projects in Africa and Asia.

iii
iv
 Table of Contents

Foreword ................................................................................................................ i

Introduction ........................................................................................................... 1

Workshop Preparation............................................................................................. 5

Workshop Objectives .............................................................................................. 7

Module 1: Introduction......................................................................................... 11

Module 2: PHE Integration ................................................................................... 13

Module 3: PHE Conceptual Model and Integrated Theme ......................................... 17

Module 4: The Behavior Change Process ................................................................ 23

Module 5: Studying Your Target Audience(s) .......................................................... 31

Module 6: Developing a BCC Strategy .................................................................... 41

Module 7: Developing IEC Materials and Activities................................................... 69

Module 8 - Pre-testing Techniques ......................................................................... 77

Module 9 - Implement, Monitor and Evaluate BCC Interventions................................ 97

Module 10 – Next Steps ...................................................................................... 100

v
vi
 INTRODUCTION

This Guide was designed for facilitators/trainers who work with nongovernmental
organizations (NGOs) implementing population, health and environment (PHE) activities
to develop a behavior change communication (BCC) intervention that supports the
achievement of the PHE project’s goals and objectives. It instructs the facilitator on how to
train participants on the basic components of a BCC intervention. It also advises how to
adapt these components for PHE projects that need integrated messages to raise
community awareness of the PHE linkages of health and pro-conservation behaviors.

This training is best suited for NGOs and/or government agencies with existing PHE or
core health/conservation activities. It is ideal for individuals from organizations that have
already participated in a workshop on PHE project design or in a PHE-related workshop in
which they developed a PHE conceptual framework, PHE project goal and objectives and
activities. Other criteria that make individuals well-suited for this training include:

• Have had some experience developing BCC activities and/or information,

education and communication (IEC) materials and activities on health,
conservation, family planning/reproductive (FP/RH) health, HIV, and/or water and
sanitation

• Already have developed some core PHE, conservation, health, FP and/or water
and sanitation messages

• Will be able to use the integrated PHE messages and IEC materials that are
developed during the training in their PHE project intervention

• Have funding to implement the BCC strategy developed during this training

What is Behavior Change Communication for PHE?

In the context of PHE, BCC is an essential part of a comprehensive program that seeks to
improve reproductive health (RH), public health, natural resources and livelihoods
outcomes of communities living in areas of rich biodiversity. BCC is a crosscutting
component and an interactive process with communities to develop tailored IEC
messages and BCC approaches using a variety of communication channels to promote
positive behaviors and sustain individual, community and societal behavior change. BCC
involves the development and implementation of communication messages,
communication activities and a supportive environment needed to promote and sustain
behavior change. IEC only refers to the development of communication materials and
activities that form part of a comprehensive BCC strategy.

1
BCC interventions for PHE programs will help to increase the target community’s
perception and understanding of PHE linkages as well as promote and support pro-
environment and pro-health attitudes and behaviors that will have a positive effect on families’
lives. While program planners and project staff do most of the planning for BCC interventions,
the community is involved heavily in developing the actual BCC activities.

A BCC strategy should be developed as part of the very first stages of project design and
then implemented throughout the life of the project. The actual BCC activities can be
designed and implemented once other program components are in place. For example,
the project may first want to establish (or improve) health product supply systems,
organize and train community-based distributors (CBDs), and identify behavior change
agents (e.g., district health officers, agricultural extension agents, fisheries groups,
community groups, etc.) before it begins its BCC campaign. As part of their training,
behavior change agents and community volunteers should be exposed to the BCC
messages identified in the BCC strategy and how to deliver them effectively.

Who should use this Facilitator Guide?

This Guide was developed for facilitators/trainers responsible for training program
planners and PHE practitioners on how to develop a BCC strategy and intervention for
their PHE project/activity. The facilitator/trainer should already be familiar with BCC and
PHE principles so s/he can effectively respond to participants’ questions and challenges
related to the exercises in this curriculum.

What is included in this Facilitator Guide?

The Guide contains 10 modules on the BCC process, developing a BCC strategy,
developing and pre-testing BCC activities and monitoring and evaluating BCC activities.
The content is drawn from BALANCED Project experience in helping PHE practitioners
develop BCC interventions and from other resources listed at the end of this document.

Each module contains one or more participatory learning exercises for teaching the topic
covered in that module. Exercises are based on adult learning principles and designed to
help participants retain the information learned. Each module includes the following:

Learning Describes what participants will be able to do as a result of completing the

Objectives exercises in the module and is an indicator of participants’ learning.

Time Indicates approximate total time allotted to conduct the module’s

exercises. Some exercises may take more or less time than indicated in
the Guide depending on the number of participants and the complexity and
length of the BCC strategy(ies) being developed.

2
 Preparation Describes the materials needed for and the prerequisites to conducting the
exercise.

Instructions Provides step-by-step guidance for conducting the exercises.

Facilitator Some modules contain Facilitator Notes. These include background

Notes information the facilitator/trainer needs to prepare for the session.

How should this Facilitator Guide be used?

The Facilitator/trainer should review the entire Guide before planning and implementing
the training. Ideally, the training should take place over a period of four consecutive days
in order to allow participants time to practice the concepts taught in the workshop.
However, the workshop could be divided into two smaller trainings—first, modules 1 to 6
for developing a BCC strategy; and next, modules 7 to 9 for designing, testing, and
implementing BCC activities. Facilitators/trainers are encouraged to adapt the sessions to
the unique context and needs of the PHE project and the training workshop participants.

If the PHE project is an intricate one, more time may be needed to develop the BCC
strategy. In such cases, a five-day (vs. four-day) training may be more appropriate.

Making this Guide as user-friendly as possible

Facilitators/trainers should always assess which of the materials—most often the support
materials in the Facilitator Notes—should be translated into the local dialect in advance of
the training. Translated materials will help ensure the information is clearly understood by
the staff implementing the BCC intervention.

3
4
 WORKSHOP PREPARATION

Planning the Training

Workshop preparation requires careful planning. Planning should begin several days or
weeks prior to the start of the training. As you prepare, identify ideal participants as:

• Project staff from one or more organizations that are implementing a PHE,
conservation, health, FP and/or water and sanitation activities. This includes the
project manager and/or field staff that would be responsible for the development
and implementation of BCC activities.

• Key personnel from the project’s stakeholders and partners who will assist with
and/or implement BCC activities.

• Individuals from organizations that plan to implement a PHE project and that have:

− Existing funds to implement a BCC strategy developed during the training

− Undergone a PHE design workshop or already have a project conceptual

framework for their PHE project

− Experience developing IEC messages and materials on health, conservation,

family planning, reproductive health, HIV and/or water and sanitation – (this
criteria is optional but helpful)

Make the logistical arrangements:

• Decide on the training date and venue. These should accommodate participants’
and facilitator(s)’ needs in terms of travel time and potential time off from existing
job responsibilities.

• Determine the per-participant costs for food, lodging, transportation to and from
the training, workshop materials (see preparation notes for each module), and the
field pre-test (see Module 8).

• Identify the training facilitator(s), assistant(s) and other resource person(s). Know
their availability, their knowledge on BCC and/or PHE, and their ability to facilitate
large groups.

5
 • If there is a need for external resource person(s) such as an artist or graphic
design staff, narrow the list of possibilities based on their availability, eagerness to
provide technical assistance, fees, etc.

• At least two weeks prior to the start of the workshop, inform the resource person(s)
personally or via letter of invitation of the goals and objectives of the training

• Confirm participation of resource person(s).

• Determine the cost per resource person, facilitator and assistant for food, lodging
and transportation.

• Determine the cost of supplies and materials needed by the resource person(s)
and facilitator(s).

• Develop a budget for the training.

Review this training guide:

• If appropriate, adapt activities and support materials based on your own BCC
experience.

Prepare the training materials

• Read all the modules several days before the training and prepare the flipcharts,
PowerPoints, etc. for each module. Some modules have lists to prepare
beforehand. Try to prepare these before the training begins.

• Collect all needed materials beforehand. This includes but is not necessarily
limited to flipchart paper (newsprint), flipchart stands, marker pens, projectors,
screens, electrical cords, nametags, notebooks, ballpoint pens, pencils and
various other supplies as noted in the preparation section of each module.

• Gather sample IEC materials from participants or other organizations.

• Gather any of the project’s baseline and/or qualitative data and results from focus
group discussions or other audience research on the knowledge, attitudes and
practices (KAPs) of the target audiences that the BCC activities seek to influence.

6
 WORKSHOP OBJECTIVES

General Objective

To increase workshop participants’ understanding of BCC and capacity to develop a BCC

intervention for their PHE project activities.

Specific objectives

By the end of the training, participants will be able to:

• Describe PHE and the benefits of PHE linkages/integration.

• Describe BCC, the stages of behavior change and the types of BCC activities
appropriate for each stage of behavior change.

• Describe the importance of and ways to study the project’s target audience.

• Develop a BCC plan that has integrated PHE messages and IEC
materials /activities.

• Develop effective IEC materials and activities.

• Pre-test IEC materials/activities for their PHE projects.

• Describe how to implement, monitor and evaluate BCC interventions.

7
8
 AGENDA

Day 1

8:00 – 8:30 Registration

8:30 – 9:00 Module 1- Introductions, Expectations, Agenda, House Rules

9:00 – 9:30 Module 2 - PHE Integration

9:30 – 11:00 Module 3 - Conceptual Framework and Integrated Theme

11:00 – 11:15 Break

11:15 – 12:00 Module 4 - Behavior Change Process

12:00 – 1:00 Lunch

1:00 – 2:30 Module 5 - Studying Your Audience

2:30 – 5:30 Module 6 - Developing a BCC Strategy: Exercise A (includes break)

Day 2

8:30 – 9:00 Review of Day 1

9:00 – 12:00 Module 6 - Developing a BCC Strategy – cont’d (includes break)

12:00 – 1:00 Lunch

1:00 - 3:30 Module 6 - Developing a BCC Strategy – cont’d

3:30 – 3:45 Break

3:45 – 5:30 Finish developing BCC strategy (end the day earlier or later than
the time indicated here as needed in order to complete the strategy)

9
Day 3

8::30 – 9:00 Review of Day 2

9:00 – 12:30 Module 7: Developing IEC Materials and Activities

12:30 – 1:30 Lunch

1:30 – 3:45 Module 8: Pre-testing Techniques

3:45 – 4:00 Break

4:00 – 4:30 Module 8: Pre-testing Techniques (cont’d)

4:30 – 5:30 Prepare for Field Pre-test

Day 4

8:30 – 9:30 Review of Day 3 (Pre-testing techniques and preparation)

9:30 – 12:30 Module 8 - Field Pre-test

12:30 – 1:30 Lunch

1:30 – 2:30 Module 8 - Field Pre-test Discussion

2:30 – 3:30 Module 9 – Implement, Monitor and Evaluate BCC Intervention

3:30 – 3:45 Break

3:45 – 5:15 Module 10 - Next steps

Day 5 Optional – extra day if more time is needed to complete the BCC
strategy or other training activities

10
 MODULE 1: INTRODUCTION

Learning Objectives:

After this exercise, the participants will be able to:

• Know the other participants.

• List their expectations for the workshop.

• Understand the objectives of the training, agenda and house rules.

Time: 30 minutes

Preparation:

• Collect the materials needed:

− flipchart stand

− flipchart paper (newsprint)

− masking tape

− colored marker pens

− scissors

− name tags of participants

− basket or paper box

− a notebook (pad of paper) for each participant

− a pen for each participant

• Label one flipchart paper (newsprint) for each of the following words:
“Expectations” and “House Rules”, respectively

• Make one flipchart paper (newsprint) with the objectives of the training and the
training agenda (see page 7 for objectives and pages 8-9 for agenda).

11
Instructions:

1. Welcome everyone.

2. Pass around a basket or box with nametags of all participants. Ask each person to
pick a nametag of one of the participants and try to find that person.

3. Once they locate that person, they should interview him/her.

4. Give the participants 10 minutes for the interview, in which they ask the following
questions (list these on flipchart paper beforehand):

• Who are you?

• Share one positive childhood memory.

• What do you wish to learn from this training?

5. Ask participants to introduce the person they interviewed to the rest of the group and
state their expectations from the training. (Note: List these on a flipchart paper labeled
“Expectations”)

6. Review participants’ expectations.

7. Review workshop objectives prepared in advance on flipchart paper. Compare these

with participants’ expectations. If there are participant expectations that will not be met
during this workshop, assure participants these will be considered for future trainings.

8. Review the agenda for the training and explain how the agenda links to achieving the
workshop objectives.

9. Discuss house rules that the participants would like to adopt for the duration of the
training to help achieve the workshop’s objectives and agenda. (Note: List the rules
that were agreed upon by the group on the flipchart paper labeled “House Rules” and
post the list on the wall.)

12
 Module 2: PHE Integration

Learning objectives:

After this exercise, the participants will be able to describe PHE and the benefits of PHE
linkages/integration.

Time: 30 minutes

Preparation:

None

Instructions:

1. Ask participants what they understand about PHE. Write their answers on a flipchart.

2. Review what PHE is.

P = Population refers to the provision of voluntary FP information and services to

address unmet need for contraception and to promote birth-spacing and other
RH practices.

H = Health can be a variety of interventions but usually involves water, sanitation,

hygiene, malaria prevention, or child health.

E = Environment can include, but is not limited to, protected area management
and biodiversity conservation (preserving the abundance and variety of all
species including endemic, endangered, microscopic and more complex
organisms on land and water). It can include a variety of approaches –
watershed management, sustainable agriculture, natural resources
management (NRM), coastal resources management (CRM), etc.

3. Explain that PHE:

• Refers to a development approach that focuses on the interactions among

population, health and environment dynamics, particularly in biodiversity-rich
areas. This approach facilitates multi-sectoral collaboration and coordination as
well as private-public partnerships that enable delivery of multi-disciplinary
interventions.

13
 • Can also be defined as “the linkage, within a community or group of communities,
of NRM or similar environmental activities and the improvement of reproductive
health—always including but not limited to the provision of family planning
services” (Engelman).

• Interventions are conceptually linked and operationally coordinated and apply

multi-disciplinary interventions delivered in a coordinated and cost-effective
fashion.

4. Ask participants why it is important to integrate P, H, and E. Write their responses on a

flipchart.

5. If not mentioned by participants, cover the following points:

• It makes sense to integrate. Projects that integrate sectors allow organizations to

address the root cause of the situation in which they are working, rather than just
proximate causes or symptoms. For example, in many areas, while there are
immediate biodiversity threats such as habitat conversion, the underlying driver for
it is population growth.

• Conservation organizations may be able to develop better relationships with

communities by integrating a health component, which allows them to provide the
communities with a tangible service.

• For health organizations, linking with NRM projects/activities often provides them
with access to communities and clients that otherwise would be impractical or too
expensive to reach.

• It can be cost effective. By combining resources, organizations can potentially

implement their projects in a more efficient manner, sharing transportation and
field staff expenses with other organizations.

• Integrated projects can fit within a wide range frameworks. This increases the
chances of building on an existing framework. Integrated projects also provide the
opportunity for the active involvement of a broader segment of the community and
can increase women’s and youth’s participation in resource management as well
as men’s participation in health decisions.

• There is better synergy. Qualitative evidence suggests that there may be a

synergistic benefit derived from integrating sectors—combined activities can
sometimes achieve more than the sum of individual activities.

6. Ask what are the advantages of PHE partnerships?

14
7. Point out that the PHE approach encourages various sectors to work together toward
a shared goal or vision. Partnerships among sectors such as health, environment,
agriculture, rural development, etc.—whether public or private—can be beneficial in:

• Increasing the scale of effort—bringing together organizations that share the same
services or outlook can create the critical mass necessary to tackle a problem.

• Combining complementary skills—bringing together organizations with different

skills allows for working on projects that require in-house expertise that either one
of the organizations individually might otherwise lack.

• Pooling financial resources—organizations can increase their power and impact by

combining financial resources.

• Minimizing overlapping activities—working with multi-sectoral NGOs and

community groups can help leverage resources, minimize overlapping activities
and create stronger programs.

• Building on existing programs and social capital—organizations can contribute to

projects that are already established in the field.

• Increasing the capacity of behavior change agents and community volunteers to

be involved in and talk about holistic solutions for a community that involve health,
conservation, livelihoods, etc.

• Gaining credibility—organizations may gain credibility by associating with other

successful organizations.

• Filling in service gaps—many organizations (especially those working in

conservation) reach remote communities that government health systems
sometimes cannot. Such partnerships can help in accessing these remote and
underserved communities with holistic interventions.

• Building capacity—organizations can gain new knowledge and technical skills by

working with partners that have different backgrounds and expertise.

• Increasing sustainability—when organizations partner with local organizations,

there is a greater chance the project will be sustainable.

• Putting the project in the larger context—working with the government, in

particular—can help link the project to a number of governmental policies at a
variety of levels and enable greater leveraging of resources.

15
8. Ask participants where they think PHE interventions will most likely succeed. List their
responses on flipchart paper.

9. If not mentioned by participants, review the following types of areas/situations where

PHE interventions make sense:

• In areas of high biodiversity—as a prevention model—when the area:

− has high richness of species, unique habitat (endemicity), or diversity of the

ecosystem

− is environmentally threatened

− has a genetic, species and ecosystem composition that currently or in the

future holds the potential to have significance for both natural ecosystem
function and for human uses

− has a population that depends on their local natural resources

• Where there are other threats to health or livelihoods, i.e. water scarcity, unstable
fisheries, deforestation, and food security.

• Where there is a need for interventions that addresses population pressure

resulting specifically from high fertility (when population pressure is the result of in-
migration, an RH project may not be the best approach).

• In communities whose members want to participate in and support the project—

and even in these, those already knowledgeable about conservation and/or
population issues will be most likely to be interested.

• Communities that already have basic governance and/or health or development

committees, along with some level of literacy, business skills, and access to
information.

16
 Module 3: PHE Conceptual Framework and Integrated
Communication Theme

Learning objectives:

After this exercise, the participants will be able to:

• Describe his/her project’s integration through their conceptual framework.

• Identify an integrated communication theme.

Time: 90 minutes

(Note: If the project does not already have a conceptual framework, developing a
conceptual framework with participants will require additional time and the workshop
schedule should be adjusted accordingly).

Preparation:

• Make sure the participants’ organization has a conceptual model for review and
validation during the training.

It is assumed that the workshop is for participants from one organization

implementing a PHE project/activity. If participants come from several
organizations implementing PHE activities, follow the adjusted instructions.

• OPTIONAL: If the organization does not have a conceptual framework and if time
permits, a framework can be developed during the workshop. If developing
conceptual frameworks for several PHE projects, you may need to hold a session
in the evening or a working group separate from the workshop (see Facilitator
Notes for resources on how to develop conceptual frameworks for PHE Projects).

• Collect the materials needed:

− flipchart stand

− flipchart paper (newsprint)

− colored marker pens

− copy of conceptual framework(s)

17
 • If you will be projecting your conceptual framework onto a screen or wall as you
review and/or revise it, you will also need the following equipment:

− laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in both laptop and projector

Instructions:

Exercise A: Conceptual Frameworks (60 minutes)1

1. Ask participants to present the project’s goals, objectives and conceptual framework.

2. Review and discuss the current conceptual framework.

3. Validate the conceptual framework to determine if the issues, threats and

opportunities are still valid. Review the linkages between these threats, the targeted
conditions and vision. (Note: If participants come from several organizations
implementing PHE activities, select one or two conceptual frameworks to review.)

4. Ask participants if the conceptual framework needs revisions in order to most

effectively illustrate the threats and opportunities. If yes, work with participants to
make any necessary revisions. (Note: if participants come from several organizations
implementing PHE activities, ask them how they might revise their conceptual
frameworks based on the exercise just conducted.)

5. Explain that the conceptual framework can help stakeholders better understand the
linkages and participate more fully in the project. The more people participating and
understanding how their environment affects, and is affected by, health and population
factors in the community, the more likely the project activities will be sustainable.

6. OPTIONAL: If the participants’ projects do not have a conceptual framework and if

time permits, help them to develop one. This may require work in the evening or a
separate session after the workshop to develop these (see Facilitator Notes for
resources on how to develop a conceptual framework.)

1
If developing a conceptual framework from the very beginning, you will need to a lot more time
for this section (see resources under Facilitator Notes), and you will need to adjust the times for
the rest of the exercises in the module.

18
Exercise B: Integrated Communication Theme(s) (60 minutes)

1. Based on the project’s goal, objectives and conceptual framework, help participants
develop an overarching integrated communication theme or concept around which all
their IEC messages can revolve. The theme/concept should be simple and resonate
with the intent of the project.

2. Review integrated communication themes from various PHE projects. Examples

include:

• “Secure Family, Healthy Communities and Healthy Environment” – from the

BALANCED-Philippines Project, Philippines

• “Planned Family, Healthy Environment for a Better Future” – from the Pwani
Project, Tanzania

• “Healthy Families and Environment for a Better Life” – from the Health of People
and Environment in the Lake Victoria Basin (HOPE-LVB) Project, Uganda

• “Care for Your Family, Care for Your Environment for a Prosperous Life” – from
the Integration of Family Planning Messages and Referrals into the Green Belt
Movement Program, Kenya

• “A Healthy Family, Healthy Forest and Productive Land” – from the Tree
Kangaroo Conservation Project (TKCP), Papua New Guinea

3. Point out that an integrated communication theme can help “brand” your project. It can
be included on most print materials (where appropriate) including IEC materials,
training manuals, job aids, and other documents related to your PHE project. It is the
theme that the community will remember—even when there are various partners
implementing the project.

4. Before the end of the session, make sure participants have developed an overarching
communication theme for the project.

5. Remind participants that the integrated communication theme will need to be pre-
tested with members of the target audience to ensure comprehension and
acceptability of the theme. Based on the pre-test, the wording of the theme may
change.

6. Explain that participants will learn pre-testing techniques later on in this training.

19
Facilitator Notes

Instructions on how to develop a conceptual framework

Instructions and PowerPoint presentations on how to develop a conceptual framework can

be found in the series of workshop materials entitled: “Designing and Implementing
Integrated Approaches to Population, Health and Environment: Workshop for Planners
and Managers” found on the PHE Toolkit at
http://www.k4health.org/toolkits/phe/designing-and-implementing-integrated-approaches-
population-health-and-environment-phe

Examples of conceptual frameworks

Integrated Population and Coastal Resource Management Project (IPOPCORM) –

Philippines

20
Tanzania Coastal Management Partners (TCMP) PHE Project – Tanzania

21
Health of the People and Environment – Lake Victoria Basin – Uganda

22
 Module 4: The Behavior Change Process

Learning Objective:

After this exercise, the participants will be able to:

• Explain the difference between behavior change communication (BCC) and

information, education and communication (IEC).

• Describe the stages of behavior changes.

• Describe the BCC needs for each stage of behavior.

Time: 45 minutes

Preparation:

• Make a flipchart paper (newsprint), PowerPoint slide or Word document (that can
be projected on a screen/wall) with the definitions of BCC and IEC (see Facilitator
Notes).

• Make a flipchart (newsprint), PowerPoint slide or Word document (that can be

projected on a screen/wall) of Figure 1: Stages of Behavior Change Model (see
Facilitator Notes).

• Make a flipchart (newsprint), PowerPoint slide or Word document (that can be

projected on a screen/ wall) of Table 1: Stages of Behavior Change and BCC
Needs (see Facilitator Notes).

• Collect the materials/equipment needed:

− flipchart stand

− flipchart paper (newsprint)

− colored marker pens

• If using PowerPoint and/or a Word document to project on a screen/wall, you will

need the following equipment:

23
 − laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in both the laptop and projector

Instructions:

Exercise A: Definitions: (15 minutes)

1. Point out that providing people with information (IEC messages and materials) does
not necessarily lead to desirable change in their behavior.

2. Explain BCC:

BCC is a process of working with individuals, communities and societies to

develop communication strategies to promote positive behaviors that are
appropriate to their settings and that provide a supportive environment that will
enable people to initiate and sustain positive behaviors.

3. Explain IEC:

Information, Education and Communication (IEC) is a process of working

with individuals, communities and societies to develop communication
strategies to promote positive behaviors that are appropriate to their settings
only.

4. Remind participants that individuals are influenced by the community and society in
which they live. Therefore, behavior change should always include a supportive
environment. When there is information, one-on-one interpersonal communication
(IPC) and a supportive environment, desirable and sustainable behavior change
among your target group(s) is more likely.

5. Reinforce the following: BCC involves IEC messages, IEC communication activities
and the supportive environment needed to initiate and sustain behavior change. IEC
only refers to communication messages and materials that form part of a BCC
intervention.

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Exercise B: Stages of Behavior Change: (30 minutes)

1. Ask participants to list the stages of behavior change. Record these on flipchart paper.

2. If not mentioned by participants, review the following, which are based on the Stages
of Change Model by Prochaska, DiClemente and Norcross (see references). Show
PowerPoint or flipchart (newsprint) of Figure 1: Stages of Behavior Change prepared
beforehand (see Facilitator Notes).

• Unaware – Person is unaware of risks/issues and its application to them

• Contemplation – Person is aware of risks but ambivalent about changing

• Decision/determination – Person prepares to make a change

• Action – A new behavior is put into action

• Maintenance – New behavior is established, but not necessarily sustained

3. Ask participants to share a behavior they changed or intend(ed) to change and identify
which stage of behavior change they were/are in. List responses on a flipchart.

4. Mention that stages of behavior change do not always happen sequentially.

Community members are at different levels of the process, and at different times.
Also, not everyone goes through all the stages. One person may go from unaware to
action straight away, while another may vacillate between contemplation and
decision/determination for a while before action is taken.

5. Review the types of BCC activities best suited for addressing each stage of behavior
change—show Table 1 (prepare this beforehand—see Facilitator Notes).

6. Point out that a combination of BCC activities is usually the best approach for
motivating and sustaining behavior change among a target group(s) because
members of the target audience will be at different stages of behavior change.

7. Remind participants that some people implementing a desired behavior will fall back to
the contemplation stage. Therefore, it is important to continue providing a variety of
communication messages and channels to address various behavior change stages.

8. Ask participants to tell you which stage of behavior change and type of BCC activity to
use for each sentence of the story that follows.

9. Provide the correct answer, if not mentioned by participants. Make sure participants
understand before proceeding to the next bullet in the story line.

25
• A young boy has a girlfriend (your primary audience)

Unaware – The boy is possibly unaware of risks of unprotected sex. Potential BCC
activities include: print materials (posters, pamphlets, etc.), mass media (TV and
radio ads), and community drama that have IEC messages to raise awareness on
the risks of unprotected sex.

• The young boy is thinking about using condoms but has heard that they reduce
pleasure.

Contemplation – The boy needs help on how to move from intention to change to
action. Potential BCC activities include: print materials, informative radio ads,
community theater/drama, as well as IPC from a peer educator (PE) or trusted
health worker.

• Young boy considers practicing safer sex.

Decision/determination – The boy needs a concrete step-by-step action plan.

Potential BCC activities include: print materials, mass media (TV and radio ads)
and peer education explaining how to practice safe sex.

• Young boy wants condoms.

Action – The boy needs to know where to get free (or inexpensive) condoms.
Potential BCC activities include: print materials (stickers, posters, fliers) on where
to purchase or get free condoms; pamphlets on how to use condoms correctly;
and IPC from a PE, pharmacist, CBD, or health care provider on how to use
condoms correctly.

• Young boy goes to buy more condoms, but

− Friends ridicule him, or

− Health clinic refuses to give him free condoms, or

− Pharmacist laughs at him when he asks for condoms, and price is too high

Action/Maintenance – The boy needs support. The most ideal BCC activity would
be IPC from peers, CBDs, and social support mechanisms, such as youth PEs or
a youth club.

• Health care providers, pharmacists, parents (your secondary audience) are

concerned about youth getting sexually transmitted infections (STIs) and pregnant.

26
 Unaware/pre-contemplation – The project needs to create awareness among this
secondary audience on the risks of unprotected sex among youth. Potential BCC
activities include: fliers on the need to support youth and advocate for their needs;
peer groups or advocacy groups organizing rallies to receive media attention and
raise the issue among parent, teachers and politicians unaware of youth
vulnerability to STIs and unwanted pregnancy.

10. Remind participants that when trying to encourage the target audience(s) to adopt
behaviors their project is promoting, the individual, community, or institution goes
through a series of steps—sometimes moving forward, sometimes moving backward,
and sometimes taking side steps. They may even revert back to old behaviors.

11. Understanding where the community is in the change process is critical when
designing a BCC strategy.

12. Finish this session by explaining the BCC process, which participants will learn during
this workshop, including how to design a BCC intervention for their PHE Project(s).

• Study your target audience(s)

• Develop a BCC strategy

• Develop IEC/BCC activities

• Pre-test techniques

• Implement, monitor and evaluate the BCC activities

13. Ask participants if they have any questions before proceeding to the next module.

27
Facilitator Notes

Definitions

BCC is a process of working with individuals, communities and societies to develop

communication strategies to promote positive behaviors that are appropriate to their
settings and that provide a supportive environment that will enable people to initiate and
sustain positive behaviors.

IEC is a process of working with individuals, communities and societies to develop

communication strategies to promote positive behaviors that are appropriate to their
settings only.

Stages of Behavior Change

BCC has its roots in behavior change theories that have evolved over time, and which
include the following:

• Diffusion of Innovation (Everett Rogers)

• Stages of Behavior Change (Prochaska, DiClemente and Norcross),

• Self-Efficacy Model (Bandura)

• Behavior Change Continuum (World Bank)

For the purposes of this training module, the BALANCED Projects uses Prochaska’s
Stages of Behavior Change model (see Figure 1 on next page).

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Figure 1: Stages of Behavior Change Model

29
Table 1: Stages of Behavior Change and BCC Needs

Stage *based on the Stages of Change Behavior Change Communication Need

model

Unaware • Information on ways to personalize risks

Person is unaware of risks/issues and • IEC materials/activities—posters, radio
its application to them. Person does not ads/drama, community theater/drama, etc.
even consider changing. about risks and personal testimonials
Contemplation • Help on how to move from intention to
Person is ambivalent about changing. change to action
Giving up an enjoyed behavior causes • BCC tools—IPC or counseling (e.g., peer
them to feel a sense of loss despite the education, counseling by health worker,
perceived gain. During this stage, etc.) and informative IEC materials
person assesses barriers (e.g., time,
expense, hassle, fear, “I know I need to,
but …”) as well as the benefits of
change.
Decision/determination • Concrete step-by-step action plan
Person prepares to make a specific • IEC materials—brochures, posters and
change. They may experiment with other print material
small changes as their determination to
change increases.
Action • Positive feedback—IPC by PEs, CBDs,
A person takes action. Any action taken health personnel, NRM staff, etc.
should be praised because it • Social support through community workers,
demonstrates the desire for lifestyle peer support groups, social groups, etc.
change.
Maintenance • Intermittent support—IPC by PEs,
Sustained behavior change community workers, and successful
community members

30
 Module 5: Studying Your Target Audience(s)

Learning Objectives:

After this exercise, participants will be able to:

• Define the target audience for their BCC interventions.

• Describe the importance of studying the project’s target audience and the ways to
do so.

Time: 90 minutes

Preparation:

• Study the participants’ PHE project goals and objectives to be sure you know who
should be the target audience (s) of the participants’ BCC interventions.

• Read any baseline studies and/or qualitative research on the participants’ project
community and/or target audience conducted as part of or prior to the
implementation of the PHE project.

• List key baseline studies and/or qualitative research results on flipchart

(newsprint), PowerPoint slide or Word document (that can be projected on a
screen/wall).

• Label one flipchart (newsprint) paper “Ideal Woman.” Underneath the title draw a
vertical line in the middle to make two columns (so you can list two sets of
comments on what is an ideal woman).

• Label another flipchart (newsprint) paper “Ideal Man”. Underneath the title, draw a
vertical line in the middle to make two columns (so you can list two sets of
comments on what is an ideal man).

• Prepare a flipchart (newsprint), PowerPoint slide or Word document (that can be

projected on a screen/wall) of Table 2: Types of Audience Research (see
Facilitator Notes).

• Collect materials and/or equipment needed:

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 − flipchart stand

− flipchart paper (newsprint)

− colored marker pens

• If using PowerPoint and/or a Word document to project on a screen/wall, you will

need the following equipment:

− laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in both laptop and projector

Instructions:

Exercise A: Your target audience: (20 minutes)

1. Explain that the primary audience(s) is the main group(s) whose conservation,
livelihood and/or health and FP behaviors the project is seeking to influence.

2. Mention that your primary audience(s) should share similar characteristics, such as
age range, gender, occupation, residence (rural vs. urban), number of children, as well
as access to print, radio and/or TV media.

3. Provide examples of types of primary audiences PHE projects have sought to

influence:

• Women and men of reproductive age living around the Saadani National Park
(Tanzania)

• Fishermen who live around the Lake Victoria Basin (Uganda and Kenya)

• Fishmongers or other persons who purchase fish from fishermen from the Western
Coast (Ghana)

• Farmers living around all wetlands of Metu woreda (Ethiopia)

• Women agriculture producer groups living in the Luangwa Valley (Zambia)

• Youth living in coastal areas bordering the Danajon Bank (Philippines)

32
4. Ask participants to identify and list the primary target audience(s) their PHE project is
trying to influence. List responses on flipchart (newsprint) or on a Word document that
is being projected on the screen/wall.

5. Help participants be very clear about the primary target audience(s) for the BCC
interventions.

6. If participants list community health workers, PEs, extension agents, CBDs,

volunteers, or other “behavior change agents” as a primary audience(s), explain that
these behavior change agents are also members of the community and will, by
default, be recipients of the BCC activities. However, these behavior change agents
actually form the part of your BCC intervention that helps the community initiate and
sustain behavior change (which is why they are not part of the target audience).

7. Mention that behavior-change agents need to know the BCC messages and how to
effectively provide the interpersonal communication and counseling (IPC/C) needed to
help community members make and sustain behavior change. As such, they should
be the primary audience for your capacity building efforts and not for your BCC
interventions.

8. If participants mention politicians, advocacy groups, etc. explain that this audience is
best influenced by and addressed with advocacy activities. Refer participants to the
Population Reference Bureau’s Repositioning Family Planning: Guidelines for
Advocacy Action, found on the PHE Toolkit at Repositioning Family Planning (see
References)

9. Once the primary target audience(s) for the participants’ PHE project(s) is clearly
defined, ask participants to list potential secondary target groups, i.e., those
individuals or groups who are not the primary focus of the project, but who influence
your primary target members. Examples of secondary audiences could include:

• Grandparents

• Elders/village chiefs in the village

• Buyers or sellers of fish and/or agricultural products

• Health care providers

10. Explain that the participants will have an opportunity to fine tune their list of primary
and secondary audiences as they develop their BCC strategy in the following module.

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Exercise B: Ideal Man/Ideal Woman: (30 minutes)

1. Divide participants into two groups—one group of women (Group A) and the other of
men (Group B). (Note: if there are no men (or women), divide by age, with the younger
participants in Group A, and the older participants in Group B.)

2. Ask each group to discuss among themselves the characteristics of the “Ideal
Woman” and the “Ideal Man.”

3. Explain that each group has to decide on only three characteristics of the “Ideal
Woman” and three characteristics of the “Ideal Man.”

4. Allow participants approximately 10 minutes to develop their list. Anticipate some

discussion and remind participants that each group needs to decide on only three
characteristics for each sex.

5. Ask the women’s group (Group A) to tell you their three characteristics of the “Ideal
Woman.” List these on the flipchart labeled “Ideal Woman” (prepared beforehand) in
the left hand column.

6. Ask the men’s group (Group B) to tell you their three characteristics of the “Ideal
Woman.” List these on the same flipchart labeled “Ideal Woman” in the right-hand
column.

7. Circle the similar characteristics of the “Ideal Woman” between the two groups.

8. Explain that if you were trying to “market” the “Ideal Woman” to both women and men
in the workshop, you would highlight the attributes that are common to both the “Ideal
Woman” list developed by the men and the “Ideal Woman” list developed by the
women.

9. Highlight the differences between the two lists (left versus right hand columns).

10. Explain that if Group A were trying to market the “Ideal Woman” to Group B, their
campaign might not be successful, because they would be trying to sell attributes
important to Group A, not to Group B. For example, if Group A says one characteristic
of an “Ideal Woman” is that she is tall and slender, but Group B says she should be
round and healthy, it would be hard to sell the tall slender woman to Group B and the
round, healthy woman to Group A.

11. Now ask the women’s group (Group A) what they listed as the three characteristics of
the “Ideal Man” and record their response on the flipchart labeled “Ideal Man”
(prepared beforehand) in the left hand column.

34
12. Ask the men’s group (Group B) what they listed as the three characteristics of the
“Ideal Man.” Record their responses in the right hand column of the same flipchart
labeled “Ideal Man.”

13. Circle the similarities in characteristics of the Ideal Man among both groups.

14. Explain how you would use this information to sell the “Ideal Man” to both men and
women in the workshop.

15. Highlight the differences between the two groups, and how this would affect women
“selling” their idea of the “Ideal Man” to men, and men “selling” their idea of the “Ideal
Man” to women.

16. Explain that this exercise demonstrates why it is so important to know your target
audience’s preferences, knowledge, attitudes and practices before developing a BCC
intervention designed to influence their behaviors.

Exercise C: Audience Research: (10 minutes)

1. Reinforce that it is important to understand your target audience as you develop your
BCC interventions and IEC messages and materials.

2. Explain that many BCC interventions have failed because Program Managers did not
understand what was important or acceptable to their target audience. Therefore, it is
important to learn as much as possible about your target audience, such as:

• What do they already know about the topic (s), i.e. PHE linkages, reproductive
health, family planning, sustainable fishing, sustainable agriculture, alternative
livelihoods, etc.?

• What rumors or misinformation about a topic have they heard and believe?

• How comfortable do they feel talking or learning about certain topic(s)?

• What are the reasons for current behaviors/practices?

• What factors influence changing behavior?

• What are their ideas about the most appropriate ways to educate and inform other
individuals like themselves?

• What are their hopes and dreams for the future, as well as their fears?

• What is their ability to read and understand print material?

35
 • Who are their role models; who do they look up to?

• How accessible is information?

• How accessible and reliable are health services?

• What are their media habits? For example, what kind of access do they have to
print media/radio/TV? What are their listening and viewing habits and preferences?
What are the most popular shows/stations? How frequently do they read or listen
to media?

• Who are their preferred spokespersons?

3. Briefly mention the types of audience research that can be used to gather information
about one’s target audience. Show a flipchart or project on a screen or wall a
PowerPoint or Word document of Table 2 (prepare this beforehand—see Facilitator
Notes).

4. Review other sources of information that can be used to gather information about the
target audience. This information can help Program Managers and staff to more
effectively design BCC activities that address the audiences’ needs as well as project
goals and objectives.

• Project baseline studies/research

• Household surveys of KAPs

• Participatory rapid appraisals

• Donor reports and country reports

• Technical assistance, workshop, and/or supervisory reports

• Service delivery reports

• Project progress reports and/or project evaluations

5. Mention that participants will not learn how to conduct audience research in this
workshop. However, they will be reviewing any quantitative and/or qualitative research
conducted for their project prior to the workshop in order to design their BCC strategy.

Exercise D: Knowing Your Audience (30 minutes)

1. Ask participants about the results of any audience research, baseline surveys and/or
other reports conducted for their project or about their target audience.

36
2. List responses on a flipchart (newsprint). (Note: If you have studied the participants’
project(s) research results before this session and made a list of results beforehand,
share with participants and ask them to add information to your list.)

3. Ask participants to comment on the findings listed on the flipchart and add other
information that might be known about the target audience and that will influence the
audience’s capacity to implement the behaviors promoted by the PHE project. (Note:
You will need this information when facilitating the BCC strategy development
session.)

4. Brainstorm how these findings will help participants formulate their BCC activities. List
responses on a flipchart.

5. Ask participants if they have any questions before proceeding to the next module.

37
Facilitator Notes

Table 2: Types of Audience Research

If assessing: And: Then:

Health statistics → • Review quantitative data from:
− Demographic Health Surveys
of your country/region
− Local government reports and
statistics
Media habits → Conduct qualitative research using:
• Focus group discussions
• In-depth interviews
• Exit interviews
Attitudes or behaviors • Audience is literate • Review Demographic Health
of target audience and/or knowledgeable Surveys of your country/region
of the topic, or
• Conduct in-depth interviews
• Audience is
geographically
dispersed, or
• The subject matter is
highly sensitive, or
• There is substantial
peer pressure

Attitudes or behaviors Target audience is low- Conduct focus group discussions

of target audience literate

38
If assessing: And: Then:
PHE links → Collect data from secondary sources,
such as:

• Project reports
• Relevant people’s organizations
(fisher folk associations,
forest/fish wardens, etc.)
• Resource users in the community
• Community leaders

39
40
 Module 6: Developing a BCC Strategy

Learning Objective:

After this exercise, the participants will be able to develop a BCC strategy.

Time: 8 to 14 hours (depending on how extensive the PHE Project is)

Preparation:

• Collect the materials needed:

− flipchart stand

− flipchart paper (newsprint)

− masking tape

− colored marker pens

• If projecting a PowerPoint presentation or Word document, make sure to have the

following equipment:

− laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in Laptop and Projector

• Prepare a flipchart (newsprint) with the list of project behaviors from a previous
PHE project—see Exercise A, instruction #3.

• Prepare a flipchart (newsprint), PowerPoint slide or Word document (that can be

projected on a screen/wall) of Table 3: Behaviors and Influencing Factors (see
Facilitator Notes).

• Prepare a flipchart (newsprint) with examples of BCC objectives for promoting

PHE linkages—see Exercise C, instruction #12—and post on the wall.

41
 • Prepare a flipchart (newsprint), PowerPoint slide or Word document (that will be
projected on a screen/wall) of Tables 4, 5, 6 and 7 (see Facilitator Notes).

• Make enough copies of the Checklist for Developing an Action Plan and Timeline
for a BCC Strategy for each participant (see Facilitator Notes).

• Note to Facilitator: It is helpful to note participants’ responses from the exercises

in this module in/on a Word document. In this way, by the end of the session, the
BCC strategy will be drafted. Otherwise, someone will have to transcribe all the
responses written on flipcharts to a BCC strategy after the workshop.

Instructions:

Exercise A: Define Specific Behavior Changes: (2 to 4 hours, depending on how many

PHE behaviors the project plans to address with its BCC intervention)

1. Explain that it is important to plan how to implement your BCC intervention before
developing any IEC materials or BCC activities.

2. Mention that participants will develop a BCC strategy over the next day or two
(depending on how many behaviors the BCC intervention seeks to influence). Based
on participants’ BCC strategy, they will later draft IEC materials, which they will pre-
test and revise during the workshop.

3. Explain that the first step in developing a BCC strategy is to define the desired
behavior your project is seeking to influence. Review some examples of behaviors that
other PHE projects have identified in their BCC strategy (Note: have this list on a
flipchart):

• Women and men of reproductive age using modern contraceptive methods

• Men and women washing their hands after using the latrine and before eating

• Men and women sleeping under mosquito nets

• Men and women using pit latrines

• Households planting new trees

• Farmers planting a mixture of nitrogen-fixing trees and crops

• Farmers practicing crop rotation

• Fishermen obeying local fishing laws

42
 • Fishermen using the right size nets to fish

• Fishermen joining/forming a savings and credit cooperative organization (SACCO)

• Households engaged in alternative livelihoods (beekeeping, milk production,

agriculture, basket weaving, etc.)

• Households using energy-saving (or fuel-efficient) stoves

4. Together with participants, list the behaviors their PHE project and BCC interventions
seek to change or influence among its primary audience(s). Because PHE projects are
multi-sectoral, you may need to list a number of behaviors per sector.

5. List each behavior on a flipchart (newsprint) or in a Word document that can be

projected on a screen or wall. (Note: If possible, draft responses in a Word document
that can be projected on a screen/wall, as this makes it easier for participants to add
to and refine the list of behaviors over the course of the workshop.)

6. When listing each behavior, ask participants to include the audience for the behavior
change. Example, “Men and women planting trees around their households.”

7. Remind participants that when identifying behaviors, the behaviors should support the
achievement of the PHE project’s goal and objectives.

8. Be aware that it may take some time for participants to identify all of the behaviors for
the primary audience(s) that their PHE project seeks to change. (Note: sometimes
during this exercise, participants end up fine-tuning their project interventions as they
think about the behaviors they are seeking to change or influence. Do not rush this
process as it lays the foundation for all of your BCC efforts.)

Note to Facilitator:

It is unlikely you will finish developing the BCC strategy in one afternoon. If you
cannot finish Exercise A – Identifying Desired Behaviors by the end of the first day,
continue the next day. On the next day, be sure to review all behaviors previously
listed and ask participants to revise as needed before proceeding. Once all
behaviors are listed, continue with Exercises B, C, D, E and F, which may take from
4 to 8 hours to complete. Take the time needed to complete the BCC strategy as it
will become the plan for the participants’ BCC intervention(s).

43
9. Once all of the behaviors have been listed, together with participants review and
delete any that cannot be addressed with BCC interventions. For example, the
following cannot be addressed with BCC activities:

• Increase FP supplies (this is a supply issue)

• Improve health care provider capacity to counsel clients (can be addressed with
training)

• Develop/enforce environmental laws (advocacy may be needed to galvanize the

government and environment NGOs to develop and/or enforce laws that protect
the environment and/or rights of women).

10. Ask participants if they have questions before continuing to Exercise B.

Exercise B: List Factors Influencing Behavior Change: (1 to 2 hours, depending on how

many behaviors there are)

1. Review any audience research discussed in the previous session (Module 5).

2. Explain the factors that positively and negatively influence whether a person will or is
able to change behavior. These factors should be addressed in the BCC strategy.
Review the following examples:

Behavior: Women and men using modern contraceptive methods

Influencing factors:
• Rumors and misconceptions about modern contraceptive methods

• Availability of FP methods

Behavior: Fishermen practicing sustainable fishing practices

Influencing factors:
• Fishermen do not see themselves to blame for lack of fish

• Lack of enforcement of gear use and of closed fishing areas

• Cost of legal gear

Behavior: Households planting a mixture of nitrogen-fixing trees and crops

(sustainable farming)

44
 Influencing factors:
• Unaware of benefits of nitrogen-fixing crops or crop rotation

• Source of nitrogen-fixing trees not known or easily available

3. Review examples of BCC behaviors and influencing factors gathered from other PHE
projects. Refer to the flipchart, PowerPoint slide or a Word document (that can be
projected on a screen/wall) of Table 3 prepared beforehand (see Facilitator Notes).

4. Based on any audience research that is available, together with the participants, list
factors that influence a person’s ability to adopt each behavior identified in Exercise A
above. Allow sufficient time for this discussion. (Note: If possible, list responses on a
Word document as you may be refining these during the workshop.)

5. Once the influencing factors for each behavior have been identified, review each one
and highlight only the factors that can be addressed by BCC activities. (Note: If you
are listing responses on a Word document, delete the influencing factors that cannot
be addressed with BCC.)

6. Mention that influencing factors such as the need for FP supplies, equipment, cost of
fishing gear, better trained health care staff, agricultural agents, etc., costs of services,
existence/enforcement of laws, etc. cannot be addressed with BCC activities. These
require improved supply chain systems, training, advocacy, etc. at a higher level, and
thus, are not part of a BCC strategy.

7. Remind participants that BCC activities are designed to address KAPs—they cannot
change systems, make supplies and/or equipment available, build capacity or
influence law enforcement.

8. Explain that the influencing factors identified will be addressed when developing BCC
objectives and IEC messages.

9. Ask participants if they have questions before continuing to Exercise C.

Exercise C: Develop BCC Objectives: (1.5 to 2 hours)

1. Explain that the next step is to develop BCC objectives for the behaviors listed during
Exercise A.

2. Mention that BCC objectives should address different stages of behavior of your target
audience. It is likely that community members are at various levels of behavior
change. Therefore, for one behavior there may be several BCC objectives.

45
3. Review examples of BCC objectives that address different stages of behavior change,
referring to a flipchart, PowerPoint slide or a Word document (projected on a
screen/wall) of Table 4 prepared beforehand (see Facilitator Notes).

4. Review examples of BCC objectives from previous PHE projects that addressed all
four stages of change for one behavior. Show Table 5 prepared beforehand (see
Facilitator Notes) or an example from your own experience.

5. Point out that your BCC objectives should also address factors that influence the
desired behavior change(s).

6. Review the examples below gleaned from the examples in Table 5, or from your own
experience.

46
 Factor influencing men and women using modern contraceptive
methods:

• Rumors and misconceptions about modern contraceptive methods

BCC Objective (with stage of behavior it addresses)

• Increase knowledge of men and women about FP methods

(decision/determination)

Factors influencing fishermen practicing sustainable fishing practices

• Fishermen do not see themselves to blame for lack of fish

• Misuse of other types of nets for fishing and drying

BCC objectives

• Increase knowledge among the fishing community about the risks

unsustainable fishing practices (unaware)

• Increase knowledge among fishing community on what are

sustainable fishing practices.(action)

Factors influencing households planting both nitrogen-fixing trees and

crops

• Source of nitrogen-fixing trees and crops not known or easily available

BCC Objective

• Increase knowledge about what are nitrogen-fixing plants and crops

and where to get them

7. Help participants develop BCC objectives for the behaviors identified previously in
Exercise A. Try to develop BCC objectives for the various stages of behavior change.
You can assume that a community ranges from “unaware” to already “taking action,”
so you will want your BCC intervention to address all levels of behavior change.

8. Remind participants that based on the BCC objectives developed, their BCC
intervention will include activities such as print materials, radio/TV spots or drama,
community drama, and peer education. Each type of BCC activity addresses a
different stage of behavior change, as mentioned previously in Module 4.

47
9. Allow sufficient time for the development of the BCC objectives. (Note: Take the time
to think through the process and how to address each stage of behavior change.)

10. After listing the BCC objectives, remind participants that the BCC strategy is for an
integrated PHE project. Therefore, it needs to promote awareness of the PHE linkages
among its target audience. This means that BCC objectives are needed for increasing
perception of PHE linkages.

11. Mention that BCC objectives that address PHE linkages should link the impact of one
behavior on one or two different sectors, i.e. the impact of using family planning on
preserving natural resources, the impact of using sustainable fishing practices on
livelihoods and health, etc.

12. Review examples of BCC objectives for promoting awareness of PHE linkages:
Explain that BCC objectives for PHE linkages most often address the “unaware”
and/or “contemplation” stage of behavior change. (Note: List the examples below on a
flipchart and post on the wall so that participants can be reminded of BCC objectives
for PHE linkages.)

• Increase perception of how large families deplete natural resources and livelihoods
for future generations (unaware)

• Increase knowledge on the economic and natural resource benefits of healthy

timing and spacing of children.(contemplation)

• Increase awareness of the impact of cutting trees on agriculture, livelihoods and

food security for future generations (unaware)

• Increase awareness of how trees improve the environment and the health of the
people who depend on it (contemplation)

• Increase awareness of risks of overfishing on livelihoods and food security for

future generations (unaware)

• Increase knowledge on the benefits to children’s health, livelihoods and the

environment of using fuel-efficient stoves (contemplation)

• Increase knowledge on how joining a community SACCO can reduce pressure on

the environment and make money available for the household and for children’s
education (contemplation)

13. Allow participants time to review their BCC objectives and add ones that address PHE
linkages as described above. Remind participants that not all behaviors lend
themselves to integrated PHE linkages.

48
14. Review the BCC objectives with the group and fine-tine the integrated ones, if needed.

15. Ask participants if they have questions before continuing to Exercise D.

Exercise D: Develop IEC messages: (1.5 to 2 hours)

1. Now that behaviors have been identified and BCC objectives have been developed, it
is time to develop IEC messages for each behavior listed. The messages should
contribute to the achievement of the BCC objectives. The IEC messages will be
incorporated into the BCC activities that will be identified shortly.

2. Explain that IEC messages need to be pre-tested with members of the target audience
to ensure comprehension and acceptability of the message. Pre-testing also helps to
fine tune the wording so that the messages are well understood and received by the
target audience. Participants will learn pre-testing techniques later in the workshop.

3. Review examples of IEC messages and how they contribute to BCC objectives. Show
the examples of IEC messages in Table 6 prepared beforehand (see Facilitator Notes)
or examples from other projects.

4. Mention that the participants will also need to develop an integrated IEC message(s)
for the integrated BCC objective(s).

5. Reinforce the following:

• IEC messages are needed for each stage of behavior change—or the stage of
behavior where project managers find their primary target audience.

• Integrated IEC messages should show the impact of a behavior on two or more
sectors.

• Integrated IEC messages most often address the unaware stage (explaining risks
of not doing a certain behavior on several sectors) or contemplation stage
(explaining benefits of doing the behavior on several sectors). However, they can
be used for action stage as well (explaining how to implement the behavior and its
impact on another separate sector). For example:

− Catching juvenile fish does not allow them to grow, reproduce and provide a
food source for the future. (unaware)

− Allowing juvenile fish to mature and reproduce will help to provide food and
income for the future. (contemplation)

− Using legal fishing gear allows juvenile fish to grow, reproduce and provide
food and income for the future. (action)
49
 • IEC messages for the decision/determination and action stages may be
integrated or not. However, “how to” messages tend to be more sector-specific.
For example:

− Conserve fish for the future. Use fish nets with larger holes to allow juvenile
fish to escape, grow and breed.

− Space your family for a healthy future. Visit a CBD in your area to get FP
methods.

− Join a SACCO to start a new livelihoods project.

6. Review tips for good messages. Messages should:

• Be short and to the point

• Emphasize the risk of certain behaviors—if the message is geared for the
unaware stage of behavior change

• Explain the benefits of behaviors the project is promoting—if the message is

geared for the contemplation stage

• Ask the audience to take action—if the message is geared for the action stage

• Be positive—reinforce an individual’s ability to choose and initiate a behavior

• Be locally appropriate

• Use the active voice

7. Remind participants that positive, action-oriented IEC messages and a supportive

network (PEs, women’s or fishermen groups, etc.) are best for “maintaining” behavior
change.

8. Begin with the first behavior and BCC objective(s) on the list (from Exercise A and C)
and develop IEC messages that contribute to the achievement of the identified BCC
objective(s).

9. Remind participants that there may be more than one IEC message for certain
objectives. (Note: If time is an issue, divide participants into teams per behavior or
groups of behaviors. However, if time permits, it is more instructive if all participants
contribute to message development.)

10. Allow ample time to develop the IEC messages, even if you have to exceed the
allotted time for this session.
50
11. Ask participants if they have questions before proceeding to Exercise E.

Exercise E: Define Your Communication Channels/BCC activities: (1 to 2 hours)

1. Explain that the participants need to choose communication channels to reach the
intended target audiences with their IEC messages. Review the variety of
communication channels that can be used:

• Print media (posters, pamphlets, buttons, stickers, bulletin boards, messages on

fishing boats, murals, sides of ox carts, billboards, napkins at bars, etc.)

• Community-based channels (local health fairs, folk drama, concerts, rallies)

• Mass media (television, radio, newspapers, magazines, public transit advertising,

internet, text blasts, mobile phone ring tones)

• IPC (adult, couple or youth PEs, CBDs, health workers, model households,
extension agents, NRM/CRM agents)

2. Remind participants that communication channels will vary depending on: a) the
message and the stage of behavior change it addresses, and b) media habits of the
intended audience.

3. Review general guidelines for selecting communication channels, referring to Table 7

prepared beforehand (see Facilitator Notes).

4. Show participants an example of communication channels with targeted IEC

messages. Refer to Table 8 prepared beforehand (see Facilitator Notes) or discuss
examples from other projects.

5. Remind participants that when conducting their audience research, it is important to

explore preferred communication channels of the target audience as well. Based on
the results of audience research, program planners can choose communication
channels that will most likely reach your audience.

6. Emphasize the importance of being creative and putting messages where the target
audiences are. For example, messages can go on coasters that go under drinks at
restaurants where fisherman congregate, RH/FP messages can be placed in
restrooms along with free condoms, etc.

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 Example:

In Tanzania, communication activities initially focused on posters as a medium

for informing the community about PHE messages. However, research showed
that many Tanzanians are illiterate. Also, the only individuals who ended up
being exposed to the poster’s messages were the few community members
that happened to be in the area where the posters were hung. Further, within
six months, the posters had faded from the tropical sun. What the team learned
was that the community liked to listen to the radio and community drama. Once
IEC messages were incorporated into a local drama group and local radio
show, the community became much more aware of the need to conserve the
environment, join a SACCO and seek FP services.

7. Point out that IEC messages should be promoted through a variety of communication
channels at the same time to ensure the target audience will hear/see messages
multiple times and through various media. Repetition of IEC messages is very
important, especially during the “unaware” and “contemplation” behavior stages.

8. Remind participants that IPC through peer education approaches, which address the
“action/maintenance” stages of behavior change, are a critical communication channel
as well as part of the supportive environment that will help to sustain behavior change.
Thus, peer education and other peer-mediated approaches should form an integral
part of a BCC strategy.

9. Together with participants make a list of BCC activities they would like to implement,
irrespective of the amount of time or funding they have at this time. Explain that it is
better to have a master list of BCC activities from which they can choose. They can
select activities they choose to implement from the master plan depending on time
and funding available.

10. Allow sufficient time to discuss and identify BCC activities and communication
channels for the IEC messages that are appropriate for the participants’ target
audience.

11. Once the BCC activities have been identified, the BCC Strategy is nearly done.
Remind participants that they may not be able to implement the entire BCC strategy at
this time. However, from the master BCC strategy, they can choose which activity to
implement and when depending on funding and time available. For example, print
materials and peer education may be two BCC activities implemented in Year 1 of
their project, while radio/TV spots or community theater/drama get added in Year 2.

52
12. Explain that you are going to take the participants through an exercise that will help
them to determine which activities they can develop and implement over the next year
or two based on the funding and other resources they have available at this time.

Exercise F: Determine Your Timeframe and Action Plan: (1 to 2 hours)

1. Explain that participants will now develop a timeframe for implementing their BCC
strategy.

2. Mention that a BCC strategy can be implemented in phases, depending on resources

available and other program elements. For example, you would not want to drive
demand for FP products until your community-based distribution system is set up, or
your health care providers or other behavior change agents have received (additional)
training. Therefore, BCC activities can/should be phased.

3. Ask participants to consider:

• how much time they have for the development and implementation of their BCC
strategy—a couple of months? a year?

• the resources they have available (funding, manpower, etc.)

• whether there is a need for training or other activities before some BCC activities
are implemented

• whether there are other factors to consider (e.g., must new staff be hired to work
on the BCC strategy?)

4. Based on time and resources available and other pending program activities, together
with participants, develop a draft timeframe for implementing their BCC intervention.
At this point, focus only on the major milestones.

5. Point out that at the time of the workshop, participants may not have all the
information they need regarding available resources or the status of other program
elements. Hence, before they can finalize their BCC strategy, they may need to
explore these factors in more depth after the workshop ends.

6. Review the checklist below for estimating the cost of developing print materials. Point
out that this information will need to be collected after the workshop. Based on what is
learned, the BCC strategy may be revised.

• What will be the cost of pre-testing the print materials? (Note: Explain that you will
cover pre-testing in the next module).

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 • Do you need an artist or graphic designer to develop the illustrations in your print
materials? If so, you will need to factor in the costs of producing several renditions
of the illustration(s) based on pre-test results.

• How much will it cost to develop the final print materials (artists, layout, etc.)?

• Will print materials be full color, two colors or black and white?

• Will print materials be printed or photocopied? If printed, what are the costs?

• How many copies do you need? You may just need 10 posters but 1,000
brochures.

• How will your print materials be distributed? Is there a cost for distribution?

• Are there any training costs for showing your behavior change agents how to use
the print materials?

• Will you factor in additional printing costs if your materials run out?

7. Review the checklist below for estimating the cost of developing and airing radio/TV
ads/drama:

• Which radio/TV station will you use? Local stations are often less expensive than
regional or national one.

• How much airtime do you need?

• Will you have to pay for the airtime, or is it for free?

• How many spots will be aired per day/per week?

• Who will develop and will record the script?

• What are the pre-production costs (scripting, casting, recording, pre-testing,

adapting the script to lessons learned from pre-testing, etc.)?

• What are the production costs (rehearsal, studio rental/hire, music rights/use fees,
tape mastering, producer/engineer time in studio to direct and record)?

• What are the post-production costs (editing/mixing studio time, producer/engineer

time to edit/mix, duplication/dubbing costs, broadcasting time)?

54
8. Review cost considerations for community drama/theater

• Do you need to pay someone to develop the script?

• How many skits are there per day/per week?

• What materials are needed for skit?

• Do the actors get paid? Are per diem and/or lodging needed for actors if they
travel to different sites?

• What equipment do you need for the skits? Radio, microphone, speakers,
costumes, etc.?

• Will you need to bring FP methods and brochures to distribute during theater?

• What are the transportation costs to and from the community site for theater?

• Are refreshments required?

9. Review the elements of the distribution/dissemination plan for IEC materials:

• How many people do you intend to reach? And, how often?

• What channel will you use?

• How and where will your IEC materials be distributed, especially if they are print
materials?

• If print, who will use the print materials and how? Have they been trained in their
use? If not, how much will training cost?

10. Ask participants to review and try to answer some of the above questions and develop
a draft timeline.

11. Remind participants that they will need the answers to the above-mentioned questions
to finalize the BCC strategy and plan after the workshop.

12. Once a draft timeframe is prepared, review the entire BCC strategy with participants
including all of the behaviors, BCC objectives, proposed IEC messages and BCC
activities and revise as needed.

55
13. During the review, allow participants to add or delete some behaviors, rephrase BCC
objectives, add or revise IEC messages and add or revise some BCC communication
channels/activities as needed. Often reviewing the entire strategy helps to see where
adjustments are needed.

Facilitator Note:

Allow time to review the entire BCC strategy. Often participants end up adding or
deleting items once they see the entire plan.

14. Encourage participants to let the BCC strategy “sit” for a week or so and revisit it later
to be sure they are happy with the content. They may see the need for still more
adjustments.

15. Ask participants if they have questions before proceeding to the next module.

16. Explain that the rest of the workshop will focus on how to develop IEC materials.

56
Facilitator Notes

Table 3: Behaviors and Influencing Factors – drawn from previous PHE Projects

Behavior Factors that can influence audiences to make a

behavior change or not:

Women and men of reproductive age • Rumors and misconceptions about FP methods
using contraceptive methods
• Lack of support from husband and/or mother-in-
law
• Poor/sporadic availability of FP methods
• Untrained health care providers who do not
know how to counsel on family planning
Pregnant women seeking antenatal • Not understanding the benefits to mother and
care/postnatal care (ANC/PNC) baby of attending ANC/PNC services
services
• Long distances to reach an ANC/PNC clinic
• Having wait times to see a health care provider
• Fear of HIV testing if they go to ANC clinic
• Men stopping/not supporting women accessing
ANC services
Men and women using mosquito nets • Using nets for other purposes such as catching
at night when they sleep or drying fish or protecting the garden from
goats
• Cost of the nets
• Lack of information on benefits of consistently
using the nets
Men and women using pit latrines • Lack of knowledge about importance and
benefits of using latrines
• Lack of knowledge about how human waste
contaminates the environment
• Lack of tools and/or resources for constructing
and maintaining latrines
Households conserving trees • Economic need to make and sell charcoal
• Not understanding the role of trees in preventing
floods, influencing rainfall, holding fertile top soil

57
Behavior Factors that can influence audiences to make a
behavior change or not:
in place, etc.
• Lack of alternative incomes that would reduce
the need to cut trees for charcoal to sell
• Not understanding sustainable agriculture
practices
Households planting trees • Lack of transportation to get seedlings
• Cost of seedlings
• Preference for certain types of trees
• Length of time to reap benefits from trees (they
grow slowly)
• Land ownership
Fishermen fishing only in the • Fishermen do not see themselves to blame for
unprotected zones lack of fish
• Need to make money; perceive government is
harassing them
• Cost of legal gear
• Fatalistic attitude, i.e. fish now with no concern
for the future
• Lack of health care services and high morbidity
and mortality due to HIV, Bilharzia, accidents,
etc. lead to a sense of having no “future”
Fishermen obeying local fishing laws • Fatalistic attitude, i.e., fish now with no concern
for the future
• Lack of enforcement of laws that protect
breeding/protected zones
• Laws unevenly enforced— larger companies
violate the law yet individual must obey
Households/Fishermen • A spending culture, not a saving culture
joining/forming cooperatives/SACCOs
• Fatalistic attitude does not help fishermen see
the benefits of saving
• Not knowing how to save or join a SACCO or

58
Behavior Factors that can influence audiences to make a
behavior change or not:
cooperative
Households planting a mixture of • Unaware of the use of nitrogen-fixing crops
nitrogen-fixing trees and crops
• Source of trees not known or easily available
• Lack of enough land for planting trees
Households practicing crop rotation • Lack of knowledge on benefits of crop rotation
• Lack of knowledge on how to rotate crops for
best results
Households using energy-saving (or • Made of mud and, thus, melt when it rains
fuel-efficient) stove
• Need for a structure to house it and the cost of
building the structure
• Attitude (people are used to the three stone
stove)

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Table 4: Sample BCC Objectives for Different Stages of Behavior Change

BCC objectives that address the unaware stage:

• (Integrated) Increase perception of PHE linkages

• Increase perception of men and women on the health risks of having too many
children

• Increase perception of risks to future generations of cutting trees for firewood and
depleting these natural resources

• Increase knowledge on health and conservation risks of traditional cook stoves

• Increase perception among fisherfolk that fish can run out

BCC objectives that address the contemplation stage:

• (Integrated) Increase knowledge among men and women of the financial, health
and conservation benefits of healthy timing and spacing of children

• Increase knowledge on the benefits of using simple fuel-saving stoves

• Increase knowledge of the health benefits of drinking clean water

• Increase knowledge of the benefits of diversifying sources of income

BCC objectives that address the decision/determination/action stages:

• Increase knowledge on different FP methods and where to get them

• Increase knowledge on how to make (or purchase) fuel-efficient stoves

• Increase knowledge on how to rotate crops for improved output

• Increase knowledge on how to manage mangrove forests

BCC objectives that address the action/maintenance stage:

• Increase number of women of reproductive age using modern FP methods

• Increase number of farmers rotating their crops with nitrogen-fixing crops

• Increase number of women joining cooperatives or community SACCOs

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Table 5: Examples of BCC Objectives from Previous PHE Projects

Behavior: Women and men using modern contraceptive methods

BCC objectives (and stage of behavior change each objective addresses)

• (Integrated) - Increase perception of how large families deplete natural resources and
livelihoods for future generations (unaware)

• Increase knowledge of men and women (and/or couples) about the benefits of healthy
timing and spacing (contemplation)

• Increase knowledge of men and women about FP methods (decision/determination)

• Increase number of FP users continuing to use modern contraceptive methods

(action/maintenance stage)

Behavior: Fishermen practicing sustainable fishing practices

BCC Objectives (and stage of behavior change each objective addresses)

• (Integrated) - Increase awareness of impact of overfishing on livelihoods and food
security for future generations (unaware/contemplation)

• Increase knowledge among the fishing community on the risks of unsustainable

fishing practices (unaware/contemplation)

• Increase knowledge among the fishing community on the benefits of sustainable

fishing practices—e.g., using legal gear, not using chemicals, not fishing in protected
areas, and following seasonable regulations (determination/decision)

• Increase number of fishermen using sustainable fishing practices

(action/maintenance)

Behavior: Households planting a mixture of nitrogen-fixing trees and crops

BCC Objectives (and stage of behavior change each objective addresses)

• Increase perception that crops and trees need “food” just as people do (unaware)

• Increase community knowledge on the benefits of nitrogen-fixing crops and trees

(contemplation)

• Increase knowledge of where to find the demonstration plots, model households

and/or trainers to learn how to plant nitrogen-fixing crops and trees
(determination/decision)

• Increase number of farmers using crop rotation techniques (action/maintenance)

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Table 6: Examples of IEC Messages for Two Behaviors from Table 5

Behavior 1: Women and men of reproductive age using contraceptive methods

BCC objectives (and stage of behavior change):

• Integrated: Increase perception of how large families deplete natural resources and
livelihoods for future generations (unaware)

• Increase knowledge among men and women (and/or couples) about benefits of
healthy timing and spacing (contemplation)

• Increase knowledge of men and women about FP methods (decision /determination)

• Increase number of FP users continuing to use family planning (action/maintenance

stage)

Proposed IEC Messages:

• Integrated: Healthy spacing of children reduces pressure on land and improves

resources for the future (increasing awareness).

• Spacing your children at least two years apart improves the child’s health and allows
family to save for school fees (explains benefits of behavior).

• Use family planning methods to space your children (explains how to space).

• Talk to the PEs or health workers in your community about how to space your
children (PEs help with action and maintenance of new behaviors).

Behavior 2: Fishermen practicing sustainable fishing practices

BCC objectives (and stage of behavior change):

• Integrated - Increase awareness of risks of overfishing on livelihoods and food

security for future generations (unaware)

• Increase knowledge among the fishing community on the risks of unsustainable

fishing practices (unaware/contemplation)

• Increase the fishing community’s knowledge on the benefits of sustainable fishing

practices such as using legal gear, not using chemicals, not fishing in protected
areas, and following seasonable regulations (determination/decision)

• Increase number of fishermen using sustainable fishing practices

(action/maintenance)

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Proposed IEC Messages:

• Integrated: Too few fish make it difficult to feed growing families (increasing
awareness).

• Integrated: Bad fishing practices reduce fish for food and income (increasing
awareness).

• Integrated: Allowing juvenile fish to mature and reproduce will provide food and
income for the future (explains benefits of behavior).

• Use legal fishing gear today to get better fish yields tomorrow (explains how to
implement desired behavior).

• Never use chemicals to fish. They poison the fish you eat and destroy the lake
(explains how to implement desired behavior).

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Table 7: Behavior Change Stage and Best Suited Communication Channels

Stage and type of information Possible Communication Channel

Unaware – • Print media

Need to provide information on ways to − Posters
personalize risks and provide personal − Pamphlets
testimonies—usually to many members
− Buttons, stickers
of the primary target audience.
− Bulletin boards
• Community-based channels
− Local health fairs
− Folk drama
− Concerts
− Rallies
− Parades
• Mass media
− Television
− Radio
− Newspapers
− Magazines
− Public transit advertising
− Internet
− Text blasts
Contemplation – • Print materials
Helps members of the target audience • Community-based channels
move from an intention to change to a
• Mass media
decision to take action.
• IPC
− Couple or youth PEs
− CBDs
− Health workers
− Model household members
− Extension agents
− NRM/CRM agents

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Decision/determination – • Mass media
Needs concrete step-by-step action plan • Community-based channels
—for an individual who is ready to take
• IPC
action.
• Print materials with “how to” information to
reinforce IPC and IPC/C and to leave with
audience as reinforcement
Action – • IPC
Needs positive feedback for having • Social support through peer support
acted (changed behavior) and social groups, social groups, etc.
support to sustain action—mostly
individual members of the target
audiences
Maintenance – • Intermittent IPC
• Social clubs and successful community
members

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Table 8: Example of Communication Channels with IEC messages

Communication Channel IEC Messages

Buttons—for project staff, community Integrated communication theme

stakeholders, and/or PEs to wear

T-shirts—for all behavior change Integrated communication theme

agents to wear (as well as community
members in general)

Poster (s)—to be placed on homes of Integrated communication theme with illustration

CBDs and extension agents, on of a model household (e.g., with three children in
project offices, health care clinics, school uniforms, fuel-efficient stove, animals in
and NRM office buildings, and in proper housing, beehives in the back yard, lots of
market places, etc. trees, proper farming practices in use, etc.)

Calendar with 12 PHE themes—one 12 IEC messages that include integrated

for each month of the year—to be messages on the topics of family planning; NRM
distributed during community and CRM; livelihoods; health; and water sanitation
theater/drama or other events and hygiene, etc.
Radio and/or TV ads 10-second spots with rotating messages, e.g.:

• Healthy spacing of children reduces pressure

on land and improves resources for the future.
• Plant trees to prevent soil erosion, flooding
and keep fertile top soil.
• Obey fishing laws to have fish for future
generations.
• Use fuel-efficient stoves to save money and
time.
Radio and/or community theater or Incorporate your IEC messages that address all
drama stages of behavior change into a community
drama.
Behavior change agents (PEs, CBDs, These behavior change agents should be given
extension agents, farmer producer the BCC materials, trained on how to use them as
groups, etc.) they talk to community members, and provided
with job aids that have the BCC messages, etc.
so they can reinforce these messages during
counseling sessions.

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Checklist for Developing an Action Plan and Timeline for a BCC Strategy

Print Materials: Items to consider when estimating the cost of developing print materials.
The costs will determine the action plan and timeline for your BCC Strategy.

 Do you need an artist or graphic designer to develop the illustrations in your print
materials? If so, you will need to factor in the costs of producing several renditions
of the illustration(s) based on pre-test results.

 What will be the cost of developing the print materials (cost of artist, layout, and
several renditions as a result of pretesting)?

 What will be the cost of pre-testing of the print materials? (Note: Explain that you
will cover the topic of pre-testing in the next module)

 Will print materials be full color, two colors or black and white?

 Will print materials be printed or photocopied? If printed, what are the costs?

 How many copies do you need—e.g., you might need only 10 posters but 1,000
brochures.

 How will you distribute your print materials? Are there costs for distribution?

 Are there any training costs for showing your behavior change agents how to use
the print materials?

 Will you factor in additional printing costs if your materials run out?

Radio/TV spots/drama: Items to consider when estimating the cost of developing and
airing radio/TV spots/drama.

 Which radio/TV station will you use? Local stations are often less expensive than
regional or national one.

 How much airtime do you need?

 Will you have to pay for the airtime, or is it for free?

 How many spots will be aired per day/per week?

 Who will develop and who will record the script?

 How much are pre-production costs (scripting, casting, recording, pre-testing,

adapting script to lessons learned from pre-testing, etc.)?

67
  What are the production costs (rehearsal, studio rental/hire, music rights/use fees,
tape mastering, producer/engineer time in studio to direct and record)?

 What are the post-production costs (editing/mixing studio time, producer/engineer

time to edit/mix, duplication/dubbing costs, broadcasting time)?

Community Theater/drama: Items to consider when estimating the costs of developing

community theater/drama. Costs will determine your BCC action plan and timeline.

 Do you need to pay someone to develop the script? If so, what are those costs?

 How many skits per day/per week?

 What materials are needed for the skit?

 Do actors/community drama members get paid? If so, how much?

 What equipment do you need for the skits? Radio, microphone, speakers,
costumes, etc.? Is there a cost for these?

 Will you need to bring FP methods and brochures to distribute during the
community theater/drama event?

 What are the transportation costs to and from the community site for the
community theater/drama event?

 Are refreshments required? If so, what is the cost?

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 Module 7: Developing IEC Materials and Activities

Learning Objective:

After this exercise, participants will be able to:

• Describe the IEC materials development process.

• Describe basic elements needed to develop good IEC materials and activities.

• Draft IEC print materials with one or more IEC messages.

Time: 3.5 hours

Preparation:

• Collect the materials needed:

− flipchart stand

− flipchart paper (newsprint)

− masking tape

− colored marker pens

• If using PowerPoint and/or a Word document to project on a screen/wall, you will

need the following equipment:

− laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in both the laptop and projector

• Prepare flipchart (newsprint) of challenges of developing IEC materials and

activities for low-literate audiences (see Exercise B, instruction #3)

• Prepare flipchart (newsprint), PowerPoint presentation or a Word document (that

can be projected on a screen/wall) of the Tips for Developing Print IEC Materials
(see Facilitator Notes)
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 • Prepare flipchart (newsprint), PowerPoint presentation or a Word document (that
can be projected on a screen/wall) of the Tips for Developing Radio Spots (see
Facilitator Notes)

• Prepare flipchart (newsprint), PowerPoint slide or a Word document of the Tips for
Developing Community Drama (see Facilitator Notes).

• If time permits to develop IEC materials during the workshop (see Exercise C),
collect materials needed:

− Copies of materials, magazine pages, etc. with pictures of families, health, FP

health facilities, trees, fishing, farming, etc., which participants can use to
develop their IEC materials

− 3 to 4 pairs of scissors

− Several rolls of tape and/or bottles of glue

− Paper or flipchart paper for developing draft posters or pamphlets

• If resources permit, consider hiring an artist or graphic artist to help with the
illustrations (Note: often there are participants who are good artists and who can
help the group with the illustrations)

Instructions:

Exercise A: Materials Development Process (5 minutes)

1. Remind participants what is meant by IEC:

IEC is a process of working with individuals, communities and societies to develop

communication strategies to promote positive behaviors that are appropriate to their
settings.

2. Begin explaining the three steps in developing effective IEC materials/activities.

• Develop draft IEC material(s) and activities based on the BCC strategy

• Pre-test and revise

• Finalize and distribute

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3. Mention that during this session we will focus on tips for developing effective IEC
materials and activities. If time permits, participants will develop one or two IEC
materials that can be used during the pre-testing practicum.

4. Point out that the participants will learn pre-testing techniques in the next session.

Exercise B: IEC Materials and Activity Development (20 minutes)

1. Explain that PHE projects are often implemented in rural areas, where education and
access to information is very limited. Therefore, your target audience may experience
the following:

• Poor reading skills due to limited education

• Poor information literacy, i.e., the ability to recognize when information is needed
to solve a problem and to locate, evaluate, and effectively use that information

• Poor visual literacy, i.e., the ability to interpret visual content and to communicate
with others about this content

• Poor media literacy, i.e., the ability to analyze and understand information in
various media formats

2. Emphasize that it is very important to take literacy into consideration when developing
IEC materials and activities. Even if a target audience is literate, IEC materials are
easier to read and remember when they are written at a lower literacy level.

3. Review the challenges of developing IEC materials for low-literate audiences— project
on a screen or wall a PowerPoint slide, flipchart or a Word document that lists these
challenges and that has been prepared beforehand. Low-literate audiences may:

• Be slow readers who have a tendency to read one word at a time—therefore, IEC
messages should be short

• Skip unfamiliar words—this is why it is critical to pre-test text and rephrase the
messages to fit the local context.

• Have difficulty understanding abstract images—thus, it is best to place images in

their own context.

• Can be distracted with a variety of fonts (typographical styles)—so use the same
font throughout material.

• Have very elementary reading skills—children learn that all sentences begin with a
capital letter and end with a period or other punctuation point, so always begin
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 sentences or phrases with a capital letter and end with a period, even if using
phrases or incomplete sentences.

4. Review the tips for developing print IEC print materials on a flipchart or PowerPoint
prepared ahead of time (see Facilitators Notes):

5. Ask if participants have any questions before proceeding.

6. Review tips for developing radio spots on a flipchart or PowerPoint prepared ahead of
times (see Facilitator Notes).

7. Review tips for developing community drama on a flipchart or PowerPoint that was
prepared ahead of time (see Facilitator Notes).

8. Ask participants if they have any questions before proceeding to Exercise C.

Exercise C: IP BCC interventions (5 minutes)

1. Remind participants that BCC includes both IEC materials and activities and the
supportive environment needed by community members to learn how to take action
and to sustain behavior change outlined in the BCC strategy.

2. Point out that it is very important to develop support systems needed to provide the
knowledge, IPC and support the community needs.

3. Review ways to develop this supportive network.

• Develop a system of PHE PEs (adult and youth). 2

• Develop or train existing youth clubs, women’s clubs, savings and loans club, or
other clubs that work with the community and who can galvanize to provide
counseling and support to community members in your PHE project activities.

• Train your behavior change agents (agricultural extension agents, NRM/CRM

officers, fishery groups, health officers, etc.) on PHE and your BCC messages.

4. Mention that participants will not learn how to develop peer education systems, etc. in
this workshop. You can refer them to the list of resources in the back of this
Facilitators Guide.

2
See BALANCED Project. 2011 Population, Health and Environment (PHE) Community-based
Distribution and Peer Education System: A Guide for Training PHE Adult Peer Educators

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 Note to Facilitator:
It takes several hours for participants to develop IEC materials during Exercise D
below. The materials they develop will be used during the Field Pre-test exercise. If
time is short, skip Exercise D and use existing IEC print materials such as posters,
pamphlets or brochures, flipcharts, etc. for the next module on Pre-testing Techniques
and Practicum.

Exercise D: IEC Materials Development practicum (3 hours)

1. Explain that participants will develop one or two draft IEC materials for their project.
The IEC material(s) should include one or more of the IEC messages from the BCC
strategy previously developed during the workshop.

2. If participants are not already working in teams, divide participants into several
working groups, preferably per project, country, or area of expertise. Each working
group will develop one print IEC material.

3. Point participants to the table of supplies and to the artist (if one was hired). Tell
participants that they can use the supplies to develop a draft print material that they
will later pre-test in the field.

4. Allow the groups time to develop their IEC materials. They can:

• Cut up existing materials and paste, glue, etc. the pictures on a piece of a paper
(can be flipchart or other paper).

• Draw the illustrations themselves or, if available, ask the artist to draw the
illustrations.

5. Walk around and provide technical support on the IEC message(s) selected (from the
BCC strategy), and on layout, etc., as needed.

6. Once the materials are completed, ask participants if they have questions before
proceeding to the Module 8: Pre-testing Techniques.

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Facilitator Notes

Tips for Developing Print IEC Materials

• Avoid illustrations and messages that are negative and attempt to highlight how
dreadful the life of a family will be if they continue with existing behaviors. Negative
messages do not necessarily motivate. They also run the risk of making the
audience feel bad about its level of poverty.

• Include illustrations of the “ideal” situation— something that reflects the hopes and
dreams of the target audience.

• If developing brochures or multi-page IEC materials, present one to two messages

per illustration.

• Limit the number of concepts/pages per material.

• Use simple language.

• Use upper case at the beginning of each sentence, and put a period after each
sentence or phrase.

• Do not write in italics or CAPS.

• Use bold or underline to emphasize words.

• Leave plenty of white space.

Put important information in a Box.

• Use short words and short sentences. This improves the readability for low-literate
audiences.

• Arrange messages in a sequence that is most logical to the audience (ideal

sequence should be pre-tested).

• Use illustrations to reinforce the text and desired behavior change.

• Use realistic illustrations that represent the community.

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 • Put illustrations to the left of the text (Note: People learned to read from left to
right, and illustrations often say more than words, thus putting the illustration on
the left improves comprehension and readability of the message).

Tips for Developing Radio Spots/Drama 3, 4

• Make sure that at least 40 percent of your target audience has access to and
listens to radio.

• Develop a creative brief.

• Develop a story board and script following these tips:

− Write to one specific person. Imagine the face of a person from your target
audience and write as if you are telling a story to that person.

− Think of your script as a play in three acts: Act 1 sets up the situation; Act 2
illustrates the problem or conflict; and Act 3 resolves the problem (provides the
benefit and overcomes the barrier).

− Write simple sentences. Sentences we speak are simpler than those we write.

− Write in the active voice. The active voice is more dynamic and forceful, and
will make your spots sound more “alive.”

− Use short, descriptive words.

− Write for the ear. Radio should have the natural, spontaneous sound of a
conversation, sometimes with the imperfections of a conversation.

− Use the same words and phrases as your target audience. People cannot do
what you are asking if they do not understand what you are saying.

− State the positive, not the negative. In general, negative statements are
harder for the listener to understand. Frequently, the listener will actually hear
that you want him/her to do the action, even when you are asking him/her not
do it!

3
Adapted from Cowan, Cate and Shafritz, Lonna. Spot On Malaria: A Guide to Adapting, Creating
and Producing Effective Radio Spots. Washington, DC. Change Project 2005.
4
UNFPA and Population Media Center. 2005 Soap Operas for Social Change to Prevent HIV/AIDs:
A Training Guide for Journalists and Media Personnel
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 • Tell people what you want them to do and why.

• State the message at least twice.

• Create a picture in the listener’s mind.

• Tell the story of others doing the behavior and being rewarded or praised for it.

• Make the listener feel something after they have listened, i.e., happy, positive,
capable of doing what is asked.

• Catch people’s attention by using music, words, sound effects, jingles, slogans, or
tag lines in an unusual way.

Tips for Developing Community Drama

• Develop a script with well-thought out, focused and tested storylines.

• Make the storylines believable. Even if not true, the audience must be able to
identify with the characters.

• Create a drama storyline that prompts the audience to reflect on their own lives
and how they would act in the same situation.

• In the storyline, be sure to include characters that model the desired behavior and
demonstrate how conflicts and issues can be resolved.

• Consider involving three characters: a) a character with positive values and who
always does the right thing; b) a character that holds negative values and who
always does the wrong thing; and c) a character who is ambivalent with regard to
values and who transitions under the influence of the positive and negative
characters, but who ultimately does the right thing.

• Drama can prompt discussion, therefore include time in the schedule for
discussion. You can use “stop-and-go” drama that triggers videos/vignettes that
pause at different points so you can stop and ask the audience to consider the
consequences of a character’s actions or how the story should continue.

• Consider interactive discussions after a drama presentation ends to increase the

audience’s level of engagement in a topic.

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 Module 8: Pre-testing Techniques

Learning Objective:

After this exercise, participants will be able to:

• Demonstrate how to pre-test IEC materials.

• Pre-test draft IEC materials with members of their project target audience.

Time: 8 to 9 hours

Preparation:

• Collect the materials needed:

− flipchart stand

− flipchart paper (newsprint)

− masking tape

− colored marker pens

• If using PowerPoint and/or a Word document to project on a screen/wall, you will

need the following equipment:

− laptop

− projector

− screen or white wall for projecting

− power cord and power strip to plug in both the laptop and projector

• Have the illustration of the Old Woman /Young Lady ready either as a PowerPoint
slide or on a Word document that can be projected on a screen or wall (see Figure
2 in Facilitator Notes).

• Make a flipchart (newsprint), PowerPoint slide or a Word document (that can be

projected on a screen/wall) of Table 9, Table 10 and Table 11 (see Facilitator
Notes)

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 • Have several sample IEC print materials available to use during the pre-test
demonstration and for participants to use as they practice pre-testing.

• Make enough copies of the sample pre-test guide for all workshop participants
(see Facilitator Notes).

• Make enough copies of the sample Pre-test Data Collection sheet to use during
the workshop and to distribute to participants to take home with them (see
Facilitators Notes).

• Arrange for a place where participants can conduct their “field pre-test.” The
place(s) should be where members of the BCC strategy target audience(s) can be
found, such as in market places, local meeting places, next to the lake or ocean
where near fishing sites or where fishermen congregate, where farmers hang out,
individual homes, etc.

• Make any travel arrangements needed to take participants to the pre-test site(s).
Be sure to include the cost of transportation in your workshop budget.

Instructions:

Exercise A: Why Pre-test (30 minutes)

1. Show the illustration of the Old Woman/Young Lady on a PowerPoint slide or a Word
document projected on a screen or wall (see Facilitator Notes).

2. Ask participants what they see. Expect participants to see an old lady, or a young
lady, or something else. List responses on the flipchart (newsprint).

3. Probe for responses until no one has an additional opinion.

4. Point out that the differences between what different participants said they saw in the
illustrations. Some will see an older woman, some will see a young lady, others may
not see either, or some may see something else entirely.

5. Show participants how the illustration could be an old woman (the “chin” of what could
be a young lady is the “nose” of the older woman, and the “necklace” of the younger
lady could be the thin mouth of the older woman).

6. Show participants how the illustration could be young lady (the “nose” of the older
woman could be the “chin” of the younger lady, and the “mouth” of the older woman
could be the “necklace” of the young lady.)

7. Ask participants what could be done to the illustration to make it clearer that it was of
an older woman.
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8. Ask participants what could be done to the illustration to make it clearer that it is of a
younger lady.

9. Explain that if you were trying to sell something to older women, but the target
audience only sees a young lady, you would not be very successful. And vice versa.

10. Point out that this is why it is very important to pre-test all IEC materials and
messages. It is critical that at least 90 percent of your target audience see and
understand the same message.

11. Review the following examples—or, examples from your own experience—that
highlight the importance of pre-testing:

Goiter prevention in Egypt: A health program was developing a poster to encourage a

group vulnerable to goiters (lack of iodine) in Egypt to use iodized salt. They drew the
picture of an unhappy young boy with his neck showing a big bulge above the collar bone
(a goiter). When pre-testing the picture, the target audience was very unhappy with the
picture and appalled that the neck would be showing (not covered as per local customs).
Moreover, they thought the boy was unhappy because he was not covered up. Based on
the pre-test, the program manager then drew a picture of a happy, healthy, smiling young
boy—his head and neck covered—with the text asking people to use iodized salt to stay
healthy. This message was more accepted by the majority of pre-test participants.

Fishing nets in Kenya: The World Wildlife Fund in Kenya

developed an IEC material geared for fishermen to
encourage them to use legal size nets with large holes to
keep from capturing turtles while fishing. During the pre-test,
both the artist and WWF program manager were surprised
to hear members of the target audience reporting that the
fish net represented in the illustration was illegal because
the holes were too small. The men in the illustration were
catching juvenile fish and in violation of the law. WWF made
another drawing of fishermen using a net with much larger
holes.

12. Explain that good pre-testing is essential for developing effective IEC materials and
activities. Reinforce the following:

• Messages and illustrations can be easily misunderstood, misinterpreted, or seen

as unacceptable by the target audience.

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 • Pre-testing helps to ensure that the target audience understands and accepts the
IEC messages and materials. If people cannot understand the IEC materials, or do
not like them, the message is lost.

• Pre-testing involves the community in the materials development process.

• It is easier to change materials before they are finalized than to find out the
materials are inappropriate after a large investment of time and resources.

13. Explain what pre-testing is:

• Pre-testing takes place before the materials are finalized so that they can be
revised based on the audience’s reactions and suggestions.

• When first drafts of the IEC materials/activities are completed, interviews are
conducted with members of the target audience to test the messages and
illustrations.

• An interviewer shows the materials to members of the target audience and asks
open-ended questions to learn if the message is well understood and acceptable.

• Most materials have to be pre-tested several times.

• Each new or revised version is tested again and again until the material is well
understood by and acceptable to the target population.

14. Review the variables that are measured during pre-testing.

• Comprehension—Do people understand the content, the call to action? Is the

language acceptable and not offensive to anyone?

• Attractiveness—Is the IEC material or radio spot interesting enough to attract and
hold the audience’s attention? Do they like it? A poster may go unnoticed if not
attractive.

• Acceptance—Are the messages and illustrations acceptable to the target

audience? If the content offends, is objectionable, or generates disagreement
among the audience, it will have a negative impact on your project.

• Involvement—Does the target audience relate to the material? Do they perceive

that the print material or radio spot is talking to them or to others? Is the call to
action something they can do? Is the message considered relevant to their lives?

15. Ask if participants have questions before proceeding to Exercise B.

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Exercise B: Pre-testing techniques (60 minutes)

1. Review the different ways to pre-test IEC materials and activities. Refer to Table 9
prepared beforehand (see Facilitator Notes).

2. Emphasize the importance of pre-testing materials individually, especially if the target

audience is low-literate. It is important to gather individual opinions that are not
influenced by others.

3. Explain that one needs to pre-test with members of the target audience who have
similar characteristics. These characteristics or profile should include:

• Education level

• Occupation

• Gender

• Age range

• Marital status

• Geographical region

• Language

4. Ask participants how many people are needed to pre-test a print IEC material?

5. If not mentioned by participants, review the pre-testing protocol in Table 10 prepared

beforehand (see Facilitator Notes).

6. Discuss how to organize a pre-testing session.

• Prepare a pre-test guide.

• Select a site(s) to pre-test where members of the target audience will be available.
When pre-testing with an individual (not a group), select a place that allows for
some privacy so that others in the area will not come over to add their comments.

• Select times to pre-test when members of the target audience are available.

• If conducting a planned interview, arrange to meet the participant at a pre-

determined site.

• Select the interviewer(s) who will conduct the pre-test interviews.

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 • Select the note-taker(s).

Tip: When at all possible, involve the artist/graphics team in the pre-test.

• Make enough copies of the IEC material for use during the pre-test.

7. Distribute copies of the sample pre-test guide to all participants (see Facilitator Notes).
Review the sample pre-test guide with participants, explaining that this guide is a
reminder for the interviewer of what questions to ask during the pretest.

8. Point out that the pre-test guide is just a guide and that the interviewer should feel free
to ask more probing questions if s/he is trying to obtain more input from the
respondent.

9. Explain what the note-taker should be doing during the pre-test:

• Label the top of every page with group name, date and page number.

• Focus on writing down key words and phrases mentioned by the respondent.

• Write down respondent’s actual words. Do not interpret.

• Record both questions and answers.

• Write “M” next to the moderator’s questions, and “R” next to the respondent’s
remarks.

• Use numbers to distinguish the responses of different respondents (i.e., R1, R2).

• Note descriptive quotes word-for-word.

10. Demonstrate how to pre-test a print IEC material. Select a participant from the group
to be a member of the target audience. Select another participant to be the note-taker.
Use a small poster or brochure with one to two illustrations and one or two written
messages on it.

11. Welcome the interviewee and introduce yourself and the note-taker.

12. Explain that the note-taker is there to take notes so that you (the interviewer) can
remember everything that the interviewee says. Ask the person being interviewed for
their permission for the note-taker to take notes before continuing with the pre-test.

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13. Following the sample pre-test guide, show how to pre-test the illustration of message
#1 first.

• Fold or cover the material so that only illustration #1 shows.

• Ask questions about illustration #1 following the pre-test guide.

• Allow the respondent to talk without interruptions.

• Be supportive of the respondent’s interpretations and comments. Remember that

we want to know what the target audience understands from their perspective.

14. Following the sample pre-test guide, show how to pre-test the text of message #1.

• Fold or cover the material so that only the text for illustration #1 shows.

• Have participant read the text. (Explain that if a member of the target audience
cannot read the text, the interviewer can read if for them.)

• Ask questions about the text following the pre-test guide.

• Allow the respondent to talk without interruptions.

• Be supportive of the respondent’s interpretations and comments. Remember, we

want to know what the target audience sees from their perspective.

15. Show how to pre-test the text and illustration of message #1 together.

• Show the picture and the text together.

• Ask questions about the picture and text following the pre-test guide.

• If necessary, explain the intended message and ask how it could be made clearer.

16. Continue pre-testing all messages in the same way as message #1 was pre-tested.

17. After all messages and text are pre-tested, explain the intention of the IEC material
and ask for recommendations on how to improve it.

18. End interview.

• Thank the respondent for his/her participation and time.

• Explain how valuable his/her comments were.

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19. Excuse the participant role-playing the community member (respondent), but do not
let the person taking notes return to the group. Sit with the person who took notes and
review together the results of pre-test role-play. Review what the participant playing
the respondent said together and agree on the notes for the exercise. Then, ask the
person playing the note-taker to join the rest of the workshop participants.

20. Emphasize that after each individual pre-test session is completed, both the
interviewer and note-taker should sit down and go over the notes. Invariably, the
interviewer may remember things that the note-taker forgot to capture. Come to an
agreement what was said before continuing with the next interviewee.

21. Mention that when the entire round of pre-tests is over, the interviewer and note-taker
should sit down to decide the following:

• Review all the notes taken and determine whether the audio/visual is “OK” or “Not
OK” based on criteria developed beforehand.

• Determine whether the text is “OK” or “Not OK” based on criteria developed
beforehand.

• Summarize suggested changes.

22. Explain that information on how to pre-test IEC materials in group interviews is in the
sample pre-test guide. However, this topic will not be covered in the workshop.

23. Ask if anyone has questions before you have participants practice.

Exercise C: Practice (45 minutes)

1. Divide participants into groups of three: a moderator (interviewer), a note-taker, and

an interviewee (person role-playing a member of the target audience). If participants
developed draft IEC materials during the workshop, make sure that the “interviewee”
is not one of the persons who developed the IEC material. Switch people around so
that the “interviewee” is not familiar with the IEC material that is being used for this
practice. If no draft IEC materials were developed, distribute copies of IEC materials
you brought with you for the practice session.

2. Make sure that each group of three has an IEC material to use during the practice. It
can be the one developed during the workshop, or it can be an IEC material brought to
the workshop beforehand.

3. Ask participants to practice pre-testing their draft IEC material with the “interviewee.”

4. Allow approximately 10 minutes for this first round of practice.

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5. Walk around to observe how the interviewers are doing. If they are doing something
blatantly wrong (like skipping the pre-test guide questions, counseling the
“interviewee, etc.), gently correct the interviewer.

6. After the first round of practice pre-testing is completed, ask participants how it went.
What would they do differently next time?

7. For the second practice pre-test, ask the person who played the “interviewee” to now
play the role of the “moderator (interviewer);” the person who took the notes to play
the role of the interviewee; and the person who was previously the
moderator/interviewer, to be the note-taker.

8. Allow participants approximately 10 minutes to practice the second pre-test.

9. If time permits, ask each small group to switch roles again so that each person in each
threesome has the opportunity to play all three roles—the interviewer, the note-taker
and the “interviewee.”

10. Be sure participants practice enough to feel comfortable pre-testing their draft IEC
material. This may mean conducting another round of practice if needed and time
permits. The more participants practice, the better they will be during the field pre-test.

11. Ask participants how the exercise went. Ask if they have questions before proceeding
to Exercise D.

12. Have the small groups of three remain together to work on the next exercise.

Exercise D: Analyzing Pre-test Results (30 minutes)

1. Distribute copies of the Pre-test Data Collection Sheet.

2. Explain that after each pre-test round, the interviewee and the note-taker should
complete the Pre-test Data Sheet based on the notes they took while pre-testing.

3. Explain how to use the Pre-test Data Collection Sheet to code the notes taken during
a pre-test.

• Review all the notes taken by the note-taker.

• Note responses on the Pre-test Data Sheet.

• Determine whether the audio/visual is “OK” or “Not OK” based on criteria

developed beforehand.

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 • Determine whether the text is “OK” or “Not OK” based on criteria developed
beforehand.

• Summarize suggested changes.

• Calculate the number and percentage of “OKs.”

• Calculate the number and percentage of “Not OKs.”

4. Remaining in the same groups of three from the pre-test practice, ask participants to
review their notes from their “pre-test practice” and complete a Pre-test Data
Collection Sheet based on their pre-test. Allow approximately 15 minutes to do this.

5. Ask participants whether their IEC materials were ready to be finalized based on the
results on their Data Collection Sheet.

6. Ask the reason why or why not.

7. Review Table 11 with participants pointing out when IEC materials still need additional
pretesting and when they can be finalized.

8. Remind participants that draft IEC materials usually need several rounds of pretesting
before they are final and ready to print or implement.

9. Remind participants how many rounds of pre-testing are usually needed before
deciding to finalize a document. Review Table 10 again (from Exercise B).

10. Answer any questions before continuing to the Field Pre-test Practicum.

Note to Facilitator:

Participants need to practice pre-testing techniques, and the best way to do that is to
have them pre-test the draft IEC material they developed in the workshop or an
existing material with real members of the target audience. This way, they experience
firsthand how interesting and useful it is to get audience feedback on their IEC
materials. Therefore, make sure to find the time to conduct Exercise E.

Exercise E: Field Pre-test Preparation (1 hour)

1. Explain that participants will be going to the field to pre-test the draft IEC material(s)
developed during the workshop (or copies of real IEC materials) with members of the
target audience of their BCC strategy.

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2. Divide participants into small groups of two to three per IEC material developed—one
will be the moderator/interviewer and another will be the note-taker. (Note: if the group
is large, add an observer to each small group, making it a group of three. Ideally, the
small group should test the IEC material they developed or be familiar with an IEC that
you have given them.)

3. Ask participants to develop their pre-test guide to use for the field practice—they may
choose to adapt the sample pre-test guide for their IEC material. Allow approximately
20 minutes to adapt the sample pre-test guide for their field practice.

4. Make sure each small group has paper and pens to take notes, and a copy of the Pre-
test Data Collection Sheet.

5. If time permits, and is needed, allow participants to make last minute revisions to their
draft IEC material that will be field tested during this exercise.

6. Explain that during the field test, each pair (or threesome) will pre-test the draft IEC
material with at least four people.

7. Point out that each person in the pair (or threesome) should have an opportunity to
play the role of both the interviewer and the note-taker.

Exercise F: Field Pre-test (3 to 4 hours)

1. Take the participants to the place(s) where they will practice pre-testing their IEC
material. (Note, you may need to go to several places if there are a lot of participants.
This should be a place or places where members of the target audience for their BCC
strategy can be found—for example in the market, next to the lake near fishing sites,
where farmers hang out, in individual households, etc.)

2. If time does not allow for a trip to the field, at least have participants practice pre-
testing with people in the office (staff, receptionist, driver, cook, security guard, etc.),
or in areas close to the workshop site.

3. Tell each team to pre-test their IEC material with at least four individuals.

4. Ask participants to find a private place to conduct the pre-test so as not to draw or
attract a crowd.

5. Remind participants to follow the pre-test guide (it is okay to read it if they do not
remember the questions), but to feel free to probe with their own words as the need
arises.

6. Remind the teams to review the notes together with their note-taker (and observer)
after each pre-test round before interviewing the next person.
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7. Remind participants to switch roles after each pre-test so that each person has the
opportunity to be an interviewer and a note-taker.

8. Excluding transportation time, give the participants two hours or so to pre-test their
IEC material (depending on how many people are in the workshop and how far they
need to go to conduct the pre-test).

9. After a pre-determined time, ask all participants to return to the workshop site.

Exercise G: Processing the Field Pre-test (1 hour)

1. When the participants have returned to the workshop site, ask them how it went.
Encourage participants to share with the larger group the highlights and results of their
field pre-test.

2. Ask what they learned from the process, and based on their practice session what
they will do differently when they pre-test their IEC materials for real.

3. List their responses on flipchart paper.

4. Be sure to allow each group to report on their experience.

5. If participants have not already done so, ask them to get together in in the same group
as during the field test and complete the Pre-test Data Collection Sheet.

6. Allow 10 minutes for them to complete the sheet.

7. Ask participants, “How does one know when to stop pre-testing?” “When is enough?”

8. If necessary, review Table 11 which has been prepared beforehand.

9. Based on the practice field pre-test, ask participants these questions about their draft
IEC material(s):

a) How well did the community understand the visual alone?

b) How well did the community understand the visual and text together?

10. Based on the completed Pre-test Data Collection sheets, ask participants to state
what will be their next step in revising or finalizing their draft IEC material developed
during the workshop. (Note: Participants do not have to commit to completing the draft
IEC material after the workshop, but they should be able to tell you what they would
do if they were to revise and pre-test it again.)

11. Ask participants if they have questions before proceeding to Module 9.

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Facilitator Notes

Figure 2 – Old Woman /Young Lady

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Table 9: Types of Pre-tests

If IEC material is: And target Then:

audience is:

Print Low-literate Pre-test draft material(s) with one member

of the target audience at a time.

Literate Pre-test draft material in a small group.

Mass media, i.e. Low-literate Pre-test draft materials individually.

video, TV, radio, etc.
Literate Pre-test draft material in small group.

Table 10: Pre-testing Protocol

If testing: Then:

With individuals, especially • Pre-test first draft with at least 10 members of the
low-literate audiences target audience.
• Pre-test subsequent draft(s) with 15-20 people.
• Pre-test final draft with 10-12 people.

In a small group • Pre-test first draft with a group of 8 -10 members

of the target audience.
• Pre-test subsequent draft(s) with a group of 10 -
12 people.

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Table 11: When to Stop Pre-testing

If: And: Then:

Visual Alone Less than 70% interpret 1. Revise visual.

correctly
2. Pre-test again with 15 -20
people.

70% or more interpret 1. Revise based on small

correctly suggestions, if needed.

2. Incorporate into final draft.

Visual and Text Less than 90% interpret 1. Revise visual and text.
correctly or do not accept
message 2. Pre-test again with 10-15
people.

90% or more interpret 1. Revise based on small

correctly and accept suggestions, if needed.
message
2. Incorporate into final draft.

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Sample Pre-test Guide

Introduction

• Introduce yourself and the purpose of the interview.

• Introduce your note-taker. Explain that the note-taker will write down participants’
suggestions so that nothing is forgotten.

• Ask permission for the note-taker to take notes.

• Tell the person that what they tell us is confidential. We will not mention names.

• Explain that we need to improve this learning material for others in the community.

• Point out that we are testing the material, not the person.

• Allow the person to speak freely without laughing, ridicule, comments to the note-
taker, etc.

FOR EACH ILLUSTRATION AND TEXT:

Show the illustration first and ask:

• What do you see in this illustration?

• What is happening?

• Why do they see what they see?

• What is happening in each section of the illustrations?

• Does this look like your community?

• Why/why not?

• Do these look like people in your community?

• Why/why not?

• Probe for other characteristics that might look like the respondents’ community
(type of dress, number of children, background activities—is the fisherman
carrying fish, for example—type of school uniforms worn by the children,
geography, types of crops in the illustration, etc.)

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Show only the text and ask:

• Can you read this message for me? (If interviewee has difficulty reading, read the
text to him/her.)

• What does the text say to you, in your own words?

• Are there any words that others might not understand?

• How do you feel about the language used?

• What do you think the message is saying?

• What do you think the message is asking you to do?

• How can we make it easier to read/understand?

Show both the illustration and text, and ask

• What do you think about the text and the illustration together?

• What do they say to you?

• Probe to understand what they do not understand.

Once you have asked all the probing questions about the illustration and text:

• At some point, explain what you intended to depict with the illustration.

• Do you think other people in your community will be able to read this text (or
understand the illustration)? If the answer is “no,” then ask “What can we do?”

• How can we improve the illustration (s)?

• Explain what you intended to say with the message(s).

• How could we better show the linkages between a healthy family and the
environment?

• How can we better convey the message(s)?

• What can we do to make this material more understandable to the community?

• How do you feel about the colors/typeface/layout of the material?

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For Group Interviews

Introduction

1. Introduce yourself.

2. Introduce the note-taker—explain that the note-taker will write down participant’s
suggestions so that we do not forget the important things s/he tells us.

3. Explain that you would like to improve this learning material for others in the
community.

4. Point out that you are testing the material, not the person.

5. Tell the respondents that what he/she tells you is confidential.

6. Distribute draft material to each member of the group.

Pre-test the IEC material

If: Then:

Print material 1. Make enough copies of the material for all respondents.

2. Pre-test the picture first (see steps for Individual pre-test).

3. Pre-test the text next:

• Have each respondent take turns reading a section of the

material out loud.

• After each section, ask the group to discuss and suggest

improvements.

• Listen for words that readers have difficulty reading or

understanding.

• Be supportive of participants’ comments.

• Note respondents’ responses on data sheets.

4. Pre-test the picture and text together (see steps for individual
pre-test).

94
 Audio material or 1. Play the audio material/video for the entire group.
video
2. Ask open-ended questions following the pre-test guide.

7. Thank respondents for their time and comments.

8. Explain how their comments have been very valuable.

9. Provide refreshments, if possible.

95
 Sample Pre-test Data Collection Sheet (adapted from Program for Appropriate
Technology in Health (PATH). Developing Materials on HIV/AIDS/STIs for Low Literate
Audiences. Washington, DC 2002)

Pre-test Data Sheet

Write which pre-
test round this is.
Topic of Material: _____________________________________

Language: _______________________ Pre-test Round: ______

Region: _________________________ Date: _____________

Interviewers: _____________________ Message No: _______ List the message

number. For
example, 4th of 10
messages (pages)
Describe Write How do What Coding of booklet.
Picture: Text: you feel would
about you Picture Text
the change?
picture
and/or
words?
Write what Respon- What do What do OK NO OK NO
the person dent # you the
says s/he
sees.
see? words
mean to
you?

Write what 1. This is the

the person response of one
says the respondent to one
words mean message.
to him/her.

2.

If there are any

If the respondent appropriate
recognizes part suggestions for
changes of the
of the picture, a
illustration or
checkmark can 3.
save the words, add it/
recorder time. these here.

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 Module 9: Implement, Monitor and Evaluate BCC
Interventions

Objective

By the end of this session, participants will be able to describe key points related to
implementing, monitoring and evaluating BCC interventions.

Time: 60 minutes

Preparation:

None

Instructions:

Implementing

1. Explain that once IEC materials are developed, it may be necessary to train behavior
change agents on their use. Ideally, IEC materials should be available during capacity-
building events/workshop to introduce the BCC messages and IEC materials. At that
time, the PEs/behavior change agents can practice using them as they role play
talking to members of the community about PHE, conservation, reproductive
health/family planning, livelihoods, etc.

2. Mention that when distributing posters, make sure to put them in places where the
members of the target audience will see them. Do not hang them were members are
already “doing the behavior.” For example, placing a poster that encourages couples
to seek health services on the outside of a health clinic is ineffective, because your
target audience is already at the health clinic. A better place to put a poster that
encourages them to visit a health center would be in the marketplace, at the local
coffee shop, grocery store or some other location where members of the target
audience congregate.

Monitoring

1. Explain why it is important to monitor and evaluate IEC materials and activities:

• Shows whether the IEC materials have been effectively distributed.

• Shows whether the IEC materials are actually being used by the health center
staff, PEs or other behavior change agents.
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 • Provides more information about whether or not the IEC materials and activities
are accepted and clearly understood by the target audience.

• Allows program planners to adapt to the changing needs of population groups with
whom the program works.

2. Review ways to monitor the reach and use of the IEC materials and/or activities:

• Inquire how many IEC materials were distributed by PEs and other behavior
change agents.

• Observe how PEs/behavior change agents use the IEC material.

• Have a “mystery client” visit a health clinic, PE or other behavior change agent and
observe if and how the IEC material(s) are being used.

• Conduct intercept interviews with clients/ potential clients/community members

outside a clinic or women’s’ group, etc. to learn what messages they heard and
whether they saw any IEC materials.

• Interview members of the target audience to inquire:

− Did they see or receive the IEC material/activity?

− Did they understand it? If not, why not?

− Do they still have the IEC material (if it is a brochure)?

− Have they shown it to their partner or a friend?

− Did the material influence a decision they made?

− Did they take the action promoted by the IEC material?

• Count the number of community members who attend a community drama.

• Interview members of the community to inquire whether they have seen the
project’s community drama or radio spot.

− Do they remember the messages from the community drama/radio spot? If so,
what were they?

− Did they take action after seeing/hearing the community drama/radio spot? If
so, what were they?

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 − If not, why?

• Conduct key informant interviews with community members after IEC activities to
gauge the use and effectiveness of the activity.

• When monitoring IEC materials or activities, ask for suggestions on how to

improve the IEC messages, material and/or activity.

3. Mention that if funds and time permit, periodically revise your BCC messages and
activities based on the results of the monitoring and evaluation efforts.

Evaluating

1. Point out that one good way to evaluate your IEC activities is to assess the
achievement of the BCC objectives in the BCC strategy.

2. Review ways to measure achievement of your BCC objectives:

• Conduct focus group discussions or one-on-one interviews with members of the

target audience to assess KAPs related to the behaviors promoted in the BCC
strategy.

• Conduct KAP surveys with members of the target audience related to the PHE
behaviors promoted by the project.

• Conduct a Behavior Monitoring Survey (BMS) prior to the implementation and a

specified period after the implementation of your BCC intervention. Refer
participants to the guide on how to develop and conduct BMS surveys found in the
References section of this Facilitators Guide.

• Conduct a Designing for Behavior Change survey. Refer participants to the guide
on how to develop and conduct the DBC survey be found in the reference section
of this Facilitators Guide.

3. Ask participants if they have any questions before proceeding.

4. Review key points and messages from the entire workshop before proceeding to
Module 10.

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100
 Module 10: Next Steps

Objective

By the end of this session, participants will be able to list the steps they need to take to
finalize their BCC strategy and BCC intervention.

Time: 1 hour, 30 minutes

Preparation:

• Collect the materials/equipment needed:

− flipchart stand

− flipchart paper (newsprint)

− colored marker pens

• If awarding certificates of completion, make sure they are printed and ready to
distribute.

• For workshop closure, invite someone such as the government or other official,
project director or a key community stakeholder to provide closing remarks.

• If refreshments will be served to celebrate the end of the workshop, arrange for
these to arrive around the time of the anticipated end of the workshop.

Instructions:

Next Steps (60 minutes)

1. Ask participants what steps they need to take in order to complete their BCC strategy.
List responses on a flipchart (newsprint).

2. Develop a timeline and assign a person responsible for each step/task listed. Add to
the responses on the flipchart labeled “BCC Strategy.”

3. Ask participants what steps are needed to develop and implement their BCC
intervention. List responses on a separate flipchart paper labeled “BCC Intervention.”

4. Develop a timeline and assign a person responsible for each task listed. Add
responses to the BCC intervention tasks on the flipchart.
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Closing – 30 minutes

1. Thank participants for their hard work and attention.

2. Ask if they have any questions before ending the workshop.

3. Distribute any support materials not provided previously during the workshop.

4. If you have asked a speaker or head of the project to provide closing marks, ask them
to speak at this time.

5. Hand out certificates of completion to each participant before closing the workshop.

6. Provide refreshments. (Optional)

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References

BALANCED Project. 2013. A Tool for Conducting Population, Health and Environment
Behavior Monitoring Surveys. University of Rhode Island, Narragansett, RI.

BALANCED Project. 2011. Population, Health and Environment (PHE) Community-based

Distribution System: A Guide for Training PHE Peer Educators. University of
Rhode Island, Narragansett, RI.

BALANCED Project. 2012. Population, Health and Environment (PHE) Community-based

Distribution System: A Guide for Training PHE Community-based Distributors University of
Rhode Island, Narragansett, RI.

Change Project (Shafritz, Lonna and Cowan, Cate). 2005. Spot On Malaria: Facilitator’s
Manual for Workshops on Adapting, Developing and Producing Effective Radio Spots.
Academy for Educational Development. Washington, DC.

Change Project (Cowan, Cate and Shafritz, Lonna). 2005. Spot on Malaria: A Guide to
Adapting, Creating and Producing Effective Radio Spots. Washington, DC: CHANGE
Project, Academy for Educational Development. Washington, DC.

Core Group. 2008. Designing for Behavior Change: Washington, DC.

D’Agnes, L. and Slater, M. January 2009. Designing and Implementing Integrated

Approaches to Population, Health and Environment: Workshop for Planners and
Managers http://www.k4health.org/toolkits/phe/designing-and-implementing-integrated-
approaches-population-health-and-environment-phe

FHI360. A Toolbox for Building Health Communication Capacity. Arlington, VA.

http://www.globalhealthcommunication.org/tools/29.

FHI360. 2002 Behavior Change Communication for HIV/AIDs: A Strategic Framework.

Arlington, VA.

FHI360. 2012. C –Bulletins: Adapting Communication Materials for Lower Literate

Audiences, Arlington, VA.

Pathfinder International. 2011. Straight to the Point: Assessing Partner Capacity for
Behavior Change Activities. Watertown, MA: Pathfinder International.
http://www.pathfinder.org/publications-tools/Straight-to-the-Point-Assessing-Partner-
Capacity-for-Behavior-Change-Activities.html

Pathfinder International. 2011. Pathways to Change: Moderator's Handbook. Watertown,

MA: Pathfinder International. http://www.pathfinder.org/publications-tools/Pathways-to-
Change-Moderators-Handbook.html
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Population Reference Bureau’s Repositioning Family Planning: Guidelines for Advocacy
Action, http://www.prb.org/pdf08/familyplanningadvocacytoolkit.pdf

Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Am
Psychol. 1992; 47:1102–4.

Program for Appropriate Technology in Health (PATH). 2002. Developing Materials on

HIV/AIDS/STIs for Low Literate Audiences. Washington, DC.
http://www.path.org/publications/files/HIV_low-lit.pdf

O’Sullivan, G.A., Yonkler, J.A., Morgan, W.and Merritt, A.P. 2003. A Field Guide to
Designing a Health Communication Strategy, Baltimore, MD: Johns Hopkins Bloomberg
School of Public Health/Center for Communication Programs.

United Nations Population Funds. Communications/Behavior Change Tools. Programme

Brief No. 1. January 2002
http://www.unfpa.org/upload/lib_pub_file/160_filename_bccprogbrief1.pdf.

UNFPA and Population Media Center. 2005 Soap Operas for Social Change to Prevent
HIV/AIDs: A Training Guide for Journalists and Media Personnel

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