By:

Rama Khadka

BEHAVIOR CHANGE COMMUNICATION

FOR LEPROSY

A STRATEGIC FRAMEWORK

FOR SIMTHALI VDC, KAVRE

Introduction

Leprosy is a communicable disease. It is also known as

Hansen’s disease and this is the world’s oldest recorded

disease. 80 % of cases in 5 countries (India, Myanmar,

Indonesia, Brazil, Nigeria).

In the context of the Leprosy epidemic, BCC is an essential part

of a comprehensive program that includes different services like

medical, social, psychological and spiritual and commodities etc.

Before individuals and communities can reduce their level of

risk or change their behaviors, they must first understand

basic facts about the disease, adopt key attitudes, learn a set

of skills and be given access to appropriate products and

services.

They must also perceive their environment as supporting

behavior change and the maintenance of safe behaviors, as

well as supportive of seeking appropriate treatment for

prevention, care and support.

Goals

To decrease the prevalence of the leprosy in the target

population.

To aware the target population about the transmission and

proper treatment of the disease.

To reduce the stigma associated with the disease.

Stakeholders

The stake holder includes:

Policymakers

opinion leaders

community leaders

Religious leaders

Local health care provider

Female community health volunteer

Members of target populations including people with leprosy.

Target population

Primary target population

People suffering from leprosy

And their family who are in close contact

Uninformed service provider

Secondary target population

Local health care provider

Religious leader

Policymakers

Social service worker

Local communities and families.

BCC Assessment

Risk situations, showing in detail how decisions are made in

different situations, including what influences the decisions

and settings for risk

Why individuals and groups practice the behaviors they do, and

why they might be motivated to change (or unable to change)

to the desired behaviors including stigma

Perceptions of risk and risk behaviors

Influences on behavior, such as barriers or benefits

Insights of opinion leaders

Patterns of service use and opinions about these services

How likely the individual seek for the available service

Existing policies

Media resources

Segment of target population

According to the demographic factor target population are

People suffering from the Leprosy falls under the lower

class or backward communities and their families

People with higher class and caste suffering from disease

According to psychosocial factor

Religious leader

Local clubs working on social issues

Local leaders

Health care provider

Behavior change objectives

Reduce the stigma and discrimination associated with

leprosy

Increase incidence of health care seeking behavior

Improved compliance with drug treatment regimens

Improved attitudes and behavior among healthcare, social

service and other service delivery workers who interact

with leprosy patients.

Improve the sanitary condition in the marginalized group.

Increased involvement of opinion leaders and

policymakers, private sector managers and community

members

Increased involvement in self-help and homecare

initiatives

BCC strategy and Monitoring and Evaluation

plan

BCC objective

Reduce the stigma and discrimination associated with

leprosy (People will gain proper knowledge about the

disease)

Increase incidence of health care seeking behavior (People

in risk and patients will seek for treatment)

Improved compliance with drug treatment regimens

(Patients will complete the treatment)

Improved attitudes and behavior among healthcare, social

service and other service delivery workers who interact with

leprosy patients. (Will be provided accurate knowledge about

mode of transmission and treatment)

Improve the sanitary condition in the marginalized group. (

prevention steps are clearly taught to the group)

Increased involvement of opinion leaders and policymakers,

private sector managers and community members (Correct

knowledge will be provided)

Increased involvement in self-help and homecare initiatives

Theme and Message

“Leprosy, like other disease it can be cured if treated

properly.”

“Let’s end stigma and work together to fight leprosy.”

Channels

a. Mass media

Television

Local radio station

Posters

Flip charts

Articles

Bulletin board

b. Persons

By health workers

Peer educators

Counselors

Other trained personnel.

c. Others

Additional means of delivery include;

Musical or dramatic performances

Community events

“gimmicks” such as key chains or stickers, t-shirts

Seminars

Role-play

Panel discussion

Group discussion etc.

Monitoring and evaluation

The following areas will be closely monitored

Reach: Are adequate numbers of the audience being reached

over time?

Coordination: Are messages adequately coordinated with

service and supply delivery and with other communication

activities?

Schedule: Are communication activities taking place on

schedule, at the planned frequency?

Scope: Is communication effectively integrated with the

necessary range of audiences, issues and services?

Quality: What is the quality of communication (messages,

media and channels)?

Feedback: Are the changing needs of target populations being

captured?

Periodic focus-group discussions and in-depth interviews will

be conducted to assess the perceptions of target

populations.

The above given areas will be closely monitored by different

modes and methods and the evaluation of the effectiveness

of BCC will be made and the further plans will be made

based on the evaluation.

Partners

The key partners will be selected for the design and implementation of the components of the BCC

NGOs

Government counterparts

Media outlets

Local newspaper

Local clubs

Graphic designer

Local traditional entertainers

Members of target populations

Other program implementers

Communication Products

The communication products include:

Print materials for peer educators, such as flip charts and

picture codes

Print materials to support health workers on specific care

issues like IEC materials

Television spots for general broadcast

Promotional materials about the project, for advocacy

Scripts for theater and street theater

Radio or television soap opera scripts

Radio jingle

Printed t-shirts and bags for volunteers

Pre-testing

Pre-testing was conducted with the both primary and secondary

target population along with the compare group. The level of

knowledge, concept, attitude, views, ideas were pre-tested in

the following areas:

Comprehension

Attraction

Persuasion

Acceptability

Audience members’ degree of identification etc.

Another VDC of the Kavre district “Chautara” was use as a

compare VDC for the pre-test through the in-depth interview

and focus group discussion etc. Data of the both community

from the pre-test was compared before the implementation

of the programme.

Implement and monitor

In this phase the BCC plan will be implemented in the intended

community. Following areas will be considered;

Coordination between all partners, programmers and channels

of the BCC strategy.

Links among critical program elements, such as supply and

demand.

Timing of the strategy

Active participation of the intended population

Regular meetings between all the partners and

stakeholders

If the intended channel is followed or not

Budgeting

In all the steps mentioned above monitoring of the strategy will

be followed constantly.

Specific personnel must be designated to make sure that the

monitoring plan is developed with input from the people who

will use it.

Evaluate

BCC interventions will be evaluated against the stated

objectives and in reference to a baseline data obtained

from the pre-test.

Baseline quantitative research may be repeated to

demonstrate changes in knowledge, attitudes and

reported behaviors relative to communication and

project-level behavior change objectives if needed.

Change can also be assessed through qualitative research

into target-group responses to interventions.

Which involves examining data designed to illustrate

changes in audience behavior.

Elicit feedback and modify the program

As soon as the evaluation stage ends, it will be clear if the

target populations acquire new knowledge and behaviors, and

communication needs may change.

The needs of target populations must be periodically

reassessed to understand where they stand along the behavior

change continuum.

There might be a need of modifications of the overall

program, as well as of the BCC strategies, messages and

approaches.

Day-to-day monitoring will provide information for making

adjustments in short-term work planning.

Periodic program reviews can be designed to take a more

in-depth look at program progress and larger-scale

adjustments or redesign.

Involving stakeholders, target audiences and partners as

much as possible will provide a better look at what is

happening; help make appropriate decisions; and make

sure that the people affected by any decisions will be

fully aware of them.

So the proper evaluation of the programme will be

performed hand change in the strategy or the overall

programme will be made if necessary.