Process of Behavior Change
The PBC framework recognizes that behavior change—and thus communication intended to influence behavior change—is a process. People usually move through several intermediate steps in the behavior change process (Piotrow et al., 1997). In addition, there is typically a correlation between increases in behaviors, such as partner-to-partner dialogue about reproductive health and subsequent use of reproductive health methods.
Furthermore, this framework suggests that people at different stages constitute istinct audiences. Thus, they usually need different messages and sometimes different approaches, whether through interpersonal channels, community channels, or mass media.
An audience can generally be described as:
- Preknowledgeable— Is unaware of the problem or of their personal risk.
- Knowledgeable— Is aware of the problem and knowledgeable about desired behaviors.
- Approving— Is in favor of the desired behaviors.
- Intending— Intends to personally take the desired actions.
- Practicing— Practices the desired behaviors.
- Advocating— Practices the desired behaviors and advocates them to others.
It is important to understand where the audience is in relation to these elements before embarking on a strategy. Progress from one element to the next increases the probability of behavior change and continuation.
Public policy and communication strategies influence both individual and collective change, establishing new community norms and, over time, providing support for stronger and more effective policies and programs. The PBC can play an important role in creating an enabling environment to support new behaviors. Advocacy is a key element in this process and can help make the desired behavior sustainable.
The PBC framework can work effectively together with a comprehensive project design and implementation approach known as the Processes and Principles of Health Communication—the “P” Process (Piotrow et al., 1997). The “P” Process was developed in 1983 and is depicted by the figure on the right.
The “P” Process steps are:
1. Analysis—Understand the nature of the health issue and barriers to change: listen to potential audiences; assess existing program policies, resources, strengths, and weaknesses; and analyze communication resources.
2. Strategic Design— Decide on objectives, identify audience segments, position the concept for the audience, clarify the behavior change model to be used, select channels of communication, plan for interpersonal discussion, draw up an action plan, and design for evaluation.
3. Development, Pretesting, Revision, and Production— Develop message concepts, pretest with audience members and gatekeepers, revise and produce messages and materials, and retest new and existing materials.
4. Management, Implementation, and Monitoring— Mobilize key organizations; create a positive organizational climate; implement the action plan; and monitor dissemination, transmission, and reception of program outputs.
5. Impact Evaluation— Measure impact on audiences, and determine how to improve future projects.
6. Planning for Continuity— Adjust to changing conditions, and plan for continuity and self-sufficiency.
For almost two decades, the “P” Process has provided a solid framework that is easily applied to strategy development, project implementation, technical assistance, institution building, and training. This framework is used collaboratively as a guide by the various stakeholders involved in designing and implementing strategic health communication programs.
Several qualities of the “P” Process make it a very useful tool for program planning and implementation:
- It is systematic and rational.
- It is continually responsive to changing environments and can be adapted to new research findings and data.
- It is practical for field applications at all levels.
It is strategic in setting and pursuing long-term objectives.
When followed in sequence, the six steps of the “P” Process are helpful in developing effective program design. The focus of this book is on step 2—strategic design. When reading through each chapter, keep step 2 of the “P” Process in mind to reinforce the level of strategic decisionmaking that is required. The focus is on designing, not implementing, a program.
Applying Step 2 of the “P” Process to design a communication strategy will also require using information obtained from conducting an analysis of the situation. Similarly, the strategic design process will require thinking ahead to issues involving the other steps of the “P” Process.
