S

Social and Behavior Change Introduction

Communication
Communication, whether through media, inter-
Livingston White1 and Nancy Muturi2 personal channels, or digital platforms, is an
1
The University of the West Indies, Mona, essential tool for not only enhancing awareness
Jamaica of issues that directly impact them, but also per-
2
Kansas State University, Manhattan, KS, USA suading the change in attitudes, behaviors, poli-
cies, and other forms of decision-making at all
Keywords levels. As Waisbord (2005) precisely puts it,
social change is the ultimate goal for development
Advocacy communication · Behavior change ·
communication and the umbrella term for com-
Communication for development ·
munication interventions that seek to achieve
Community dialogue · Edutainment ·
societal transformations, which can be attained
Evaluation · Participatory communication ·
from multidimensional and multidisciplinary
Social change · Storytelling
perspectives.
Over time, communicators including
Definition researchers, scholars, and practitioners have
acknowledged that for sustainable change to
Social and behavior change communication occur, it is crucial to focus not only on persuading
(SBCC) entails addressing issues that impact peo- individual risk factors and behaviors but also
ple directly or indirectly and that require behavior broadly on change at a broader scope and long-
change at the individual, societal, national, and term impact. This implies the use of strategies that
international levels. Such issues include health, seek to inform, educate, and motivate change to
environment, economic, risk, disaster prepared- address the issues at the societal level and that are
ness, and climate change among other social and strategic and evidence-based. Furthermore, the
developmental challenges. It is a multifaceted recommended change must also be specific to
communication approach to addressing chal- the targeted population and to the required
lenges that hinder access to basic human needs change, both of which are based on research to
including food insecurity, shelter, clothing, clean determine the issue and its impact. Involved in
water, basic education, health care, and security, this approach is advocacy communication to sup-
among other factors and social injustices that con- port both structural and environmental changes as
tribute to various inequalities at a societal level. well as policies that can support that change
(Wilkins 2014). Tufte (2012) focused on the
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023
C. Fourali, J. French (eds.), The Palgrave Encyclopedia of Social Marketing,
https://doi.org/10.1007/978-3-030-14449-4_216-1
2 Social and Behavior Change Communication

socioeconomic and political factors that lead to through various media and interpersonal channels
anxiety, social instability, and insecurity noting to create awareness and education about the inno-
the need for effective communication to address vations, new products, or behaviors, but with a
those issues at a societal level. limited engagement of the targeted audience,
which was later challenged and has become a
core element in the SBCC approach.
The Evolution of the SBCC Approach The role of media in development has also
been central to SBCC. In his seminal piece,
The SBCC approach has, in the last two decades, Mass Media and National Development,
become the buzzword for change interventions Schramm (1964) recognized the role mass media
that seek to improve people’s lives by providing could play in the transformation of societies and
information, access to resources, and influencing improve the lives of people by supplementing
policies to support long-term impact. The term information gained from other resources such as
evolved from the traditional information dissemi- schools and field workers. Schramm advocated
nation strategies that are associated with top-down for the use of little media and big media
communication where change agents played a key depending on the type of development issue and
role in educating the public about the risks or the size of the audience to be reached. Today,
providing other social and development-related SBCC approach use multimedia strategies for
information. information dissemination and interpersonal com-
Top-down communication, which was munication including digital interactions to influ-
informed theoretically by the diffusion of innova- ence attitude and behavior change.
tions (Rogers, 2003) and other earlier communi- The original communication and development
cation models, sought to describe the information models emphasized the role of change agents
dissemination process that aimed at behavior including extension officials, health care workers,
change or promoting the adoption of innovations outreach officers, and other field workers as cen-
or the recommended actions and behaviors. For tral to the communication process, specifically in
example, in the SMCR (source, message, channel, imparting knowledge, awareness, and persuading
and receiver) model David Berlo (1960) described behavior. However, research shows that the IEC
the process of information transmission from the approach and the models used contributed to the
source of the message to the targeted audience. knowledge, attitude, and practice gap (KAP gap)
Similarly, McGuire’s (2012) information pro- where people were aware of the communicated
cessing model focuses on message efficiency issues and the risks involved but failed to adopt
and describes the characteristics of source, mes- the recommended actions. Recent years have seen
sage, channel, and receiver that would ensure the a change of paradigm in the communication
message reaches the destination or the targeted models and processes with more focus on com-
behavior. However, these models do not address munity engagement and participation in the iden-
the behavior change process and factors that deter- tification of the problems that impact their
mine if the change will occur. societies and culturally relevant solutions that
The early models informed many communica- focus on change at the societal level.
tion and behavior change approaches commonly
practiced in SBCC programs over time, although
some have been deemed inefficient for failure to SBCC and Health Communication
impact change. For instance, the information edu-
cation and communication (IEC) approach is Health, as a key determinant of social and eco-
widely used in agriculture extension, socioeco- nomic development, is one of the focus areas of
nomic development, environment, health, and SBCC that may be addressed from various per-
family planning programs over the years. This spectives. Health communication entails behavior
strategy entails information dissemination change communication that seeks to improve
Social and Behavior Change Communication 3

individual and societal health and well-being. sociocultural norms, and where myths and mis-
However, it is one field that receives limited suc- perceptions about condom use are strongly held.
cess due to the unique difficulties in changing Additionally, gender inequity which includes
human behavior and the ineffectiveness of norms that lend women and girls powerless and
approaches used to influence individual decision- prone to sexual violence including rape, sexual
making. subordination and inability to negotiate condom
The HIV/AIDS epidemic is an example of use, early marriages, and other reproductive
where the IEC model failed to show impact on a health risks (Murphy et al. 2006) are key socio-
larger scale. Although there has been some reduc- cultural factors in HIV prevalence but often not
tion in HIV prevalence, AIDS-related morbidity, addressed in prevention intervention that focuses
and mortality, which is attributed to increased on awareness and individual behavior change.
awareness, risk perception, adoption of preven- A more recent example is COVID-19, a global
tive measures, improved medical interventions, pandemic that disproportionately impacted many
and availability of antiretroviral (ARV) therapies, low-income and ethnic minorities in many devel-
the epidemic has persisted in Africa, Asia, and oped nations. Although information about pre-
Caribbean societies despite enormous human vention measures was available through the
and financial resources from the global media, social media platforms, and community
communities. communication channels, the pandemic claimed
Communication ineffectiveness is associated the lives of millions of people globally. Social,
with the failure to reduce HIV prevalence, which cultural, economic, and environmental factors
has prompted other behavior change interventions including residence, cultural norms, values, reli-
in highly impacted regions. For example, USAID gious practices, and occupation, among other fac-
promoted the ABC (abstinence, behavior change, tors, prevented active adherence to preventive
and condom use) approach that focused on measures that included social distancing, face
abstaining from sexual activities, mutual monog- covering, handwashing with soap and water,
amy, and condom use as the three key behaviors avoiding contaminated spaces, testing, and seek-
that would prevent the spread of HIV. This ing health care in case of exposure (Muturi 2022).
approach was to some extent attributed to the The impact of the disease on low-income ethnic
decline of the HIV prevalence rate in Uganda in minorities necessitated a change in communica-
2001 from 15% in the 1990s to about 5% in 2001 tion strategies that went beyond information dis-
(USAID 2003). Other countries with reported semination to focus on the socioeconomic and
declines in HIV prevalence in the 1990s which cultural contexts. Religiosity, for example, plays
were attributed to the ABC approach included a key role in the African, African American, and
Zambia, Cambodia, Dominica Republic, and Caribbean cultures, and successful SBCC inter-
Thailand, but the approach failed to work in ventions must consider that role.
many other highly impacted countries. Although The lack of behavior changes in the prevention
global rates have declined gradually over time in of the AIDS and other communicable and non-
many highly impacted regions, mostly in the communicable diseases that impact societies has
Global South, the prevalence in some sub- consistently prompted the international commu-
Saharan African countries, for example, Lesotho nity to develop alternative models that focus on
and Swaziland, remained as high as 20% by the the sociocultural and behavioral factors that
late 2000s (UNAIDS 2017), and higher in specific enhance risk or hamper risk reduction. For
populations globally (e.g., migrants, fishing com- instance, the UNAIDS developed the Communi-
munities, sex workers, men who have sex with cation Framework in the 1990s, which identified
men, etc.). various weaknesses in the approach and theories
The ABC approach that focused mainly on used, thus emphasizing the use of strategies that
individual behavior was not ideal in cultures consider the variation among the political, socio-
where polygamy and large families are economic, and cultural contexts that prevail in the
4 Social and Behavior Change Communication

impacted regions (UNAIDS/PennState 1999). Preventing chikungunya, a viral disease that is

Scholars have also acknowledged the role of soci- spread through mosquito bites, also requires inter-
ety and cultures in the formation of risky sexual personal communication within the cultural con-
behaviors and emphasize the importance of text. The disease has had outbreaks in countries in
addressing those behaviors from a social-cultural Africa, the Americas, Asia, Europe, the Carib-
context for sustainable behavior change bean, India, and the Pacific Ocean (CDC 2022),
(Airhihenbuwa and Obregon 2000; Muturi 2005). and required different communication strategies
Similarly, the Ebola outbreak in West Africa that are culturally specific and tailored to address
required a change in communication strategies behavior from a societal perspective. In Brazil, for
that allowed agencies to use culturally acceptable example, prevention required community engage-
channels of communication especially due to the ment and understanding of their information
distrust of government authorities and health pro- needs, which included informative and educative
fessionals in the region, coupled with the conspir- strategies to increase risk awareness and danger
acy theories that the disease was brought to the alerts (Jesus et al. 2021).
region on purpose by Westerners. Burial customs SBCC strategies have also been necessary for
were attributed to widespread disease and quick mitigating female genital mutilation (FGM), a
succession to death. The fear of uncertainty, death, practice that involves total or partial removal of
and threatening situations contributed to stronger female genitalia without a medical purpose. FGM
social relations and an increase in customary rit- is widely practiced in many societies in Africa,
uals, which enhanced the risk of infection Asia, the Middle East, and South America despite
(Allgaier and Svalastog 2015). Eradicating the its adverse health risks including death among
disease required the use of online health strategies young women and girls. Prevention strategies
and mobile devices to communicate verbally include health education interventions that target
through video recordings in local languages to girls and their parents, and medicalization of the
dispel myths, misperceptions, and correct mis- procedure where medical professionals perform it
information, encouraging video sharing through to reduce the severe risk of death thus mutating
WhatsApp and other phone applications com- women and girls’ body parts with no apparent
monly used in the region. reason. A systematic review of FGM communi-
In the USA and other more developed coun- cation strategies shows that sociodemographic
tries, cardiovascular diseases (CVDs) dispropor- factors including age, ethnicity, language, gender,
tionately impact ethnic communities compared to marital status, and residential status as well as
their White counterparts, which is often attributed cultural beliefs, norms, and values all contribute
to the culture that embraces risk-taking behaviors to the risky practices. Waigwa et al. (2018) sug-
including smoking, lack of physical activity, poor gest a collective change in behavior, attitudes, and
nutrition leading to obesity, and lack of regular the social norms and values that support the prac-
health care to detect preventable diseases such as tice in addition to the health education and societal
hypertension and diabetes. The food culture of interventions that focus broadly on gender
Black communities contributes to premature empowerment and the improved reproductive
cardiovascular-related morbidity and mortality health of women and girls in the impacted
alongside the mistrust of White health care pro- communities.
fessionals, stemming from years of racism and
oppression and lower trust in physicians, and
lower satisfaction with care (York and Tang SBCC Strategies
2021). Preventing the disease therefore would
need to focus broadly on these elements and Over time researchers, scholars, and practitioners
emphasize building trust and collective efficacy in the health, social, and development fields have
at a societal level as opposed to focusing only on developed strategies or approaches that focus on
individual behavior change. change beyond individual risk-taking behaviors
Social and Behavior Change Communication 5

or decision-making. The participatory communi- interventions that are realistic and achievable,
cation approach, for example, focuses on engag- and that work in addressing the issues. Singhal
ing communities in identifying the issues that and Dura (2012) refer to this self-discovery at the
impact societies and prioritizing them based on community level as positive deviance where pos-
their needs and collectively identifying culturally itive behaviors among a few members are identi-
appropriate solutions. The community-based par- fied and adopted and reinforced for the benefit of
ticipatory approach emphasizes the partnerships the larger social change. Like participatory com-
among stakeholders in knowledge development, munication, the positive deviance strategy also
sharing, and in the design and implementation of entails listening to the communities and holding
social and behavior change interventions within dialogues to determine what has worked in
communities. addressing social and development issues and
Similarly, the culture-centered approach, risks that impact them. Positive deviance strategy
which shares the same participatory communica- has been used in combating endemic malnutrition
tion principles, foregrounds community agency in Asia (Singhal and Dura 2012) and continues to
and the capacity of communities in the change be explored in addressing other social and devel-
necessary for the health and well-being of their opment issues with support from the international
members (Dutta 2007). Through engagement and community.
dialogic communication, communities attain The entertainment-education strategy com-
ownership of social and behavior change inter- monly referred to as edutainment, enter-educate,
ventions that they collaboratively develop, and infotainment is also commonly used in SBCC
which enhances sustainability. The engagement programs. The strategy involves the use of media
strategy through community dialogues provides programs, for instance, radio and television soap
conducive environments for communities to share operas, music, comic books, etc. that intentionally
their knowledge and experiences, which is critical incorporate one or more educational issues in an
in SBCC. entertainment format to influence the viewers’
The storytelling strategy, also viewed as criti- knowledge, attitudes, and behavior (Papa et al.
cal in effective SBCC interventions, is the act of 2000). The strategy is associated with the success
constructing identity through narrative discourse, stories of HIV communication programs in the
which gives them a sense of belonging and their 1980s and 1990s at the peak of the epidemic and
willingness to participate in a neighborhood prob- remains popular in SBCC programs. For instance,
lem (Kim and Ball-Rokeach 2006). It also entails the Hum log (We People) program used television
empathy, deliberate and attentive listening to one soap operas to address women’s reproductive
another, and a diversity of voices that demonstrate health and reached about 10% of India’s 800 mil-
the diverse nature of communities and how each lion that owned a television in the 1980s. The Soul
group is impacted. Through such discourse on City HIV prevention program in South Africa also
issues that impact them, community members used a well-scripted storyline, and high-quality
develop collective efficacy, defined as the media material, that aired during evening prime
community-level belief that they can do what time thus reaching a large audience (Singhal and
they want or must do collectively in addressing Rogers 2012). In Tanzania, the Twende na Wakati
issues that impact their communities (Kim and (Let’s Move with Times) program that used soap
Ball-Rokeach 2006). In case of pandemics, or operas to communicate about HIV/AIDS was not
other health or social issues, communities develop only effective in motivating the adoption of pre-
collective efficacy to mitigate them, but this ventive behavior but also a cost-effective strategy.
requires adequate knowledge and understanding And in the Caribbean, the Ashe Company, a cul-
of the issues for meaningful dialogues and effi- tural entertainment group, through their TABS
cacy to collectively address them. (Talk About your Business Safely) project, uses
The listening and community dialogues con- performance arts in their efforts toward attaining
tribute to the community’s self-discovery of the United Nations goal of ending HIV/AIDS by
6 Social and Behavior Change Communication

2030 (Edutainment Musical and Media Produc- segmentation, and targeted program implementa-
tion n.d.) tion and evaluation.
Furthermore, the participatory approach
emphasizes community-level communication
Challenges to the SBCC Approach that is engaging and enables knowledge building
and sharing among the target audience but neu-
The focus on social and cultural changes in SBCC tralizes the role of the change agent who may play
programs in addition to behavior change has now the facilitation role. A key SBCC challenge is
been embraced as more effective in sustainable improving the understanding of interventions to
and long-term development, particularly when influence population-level behavior (Christofides
coupled with structural and environmental et al. 2013). SBCC interventions deal with tech-
changes. For example, promoting community nical health, environment, agriculture, and other
health by increasing the level of physical activity scientific issues that require adequate knowledge
would require structural changes that include which is a precursor for community action and for
constructing walking and biking trails and other them to engage in meaningful dialogues. This
built environments. This would require commu- implies the need to integrate top-down communi-
nity buy-in, involvement, and additional cation and engage the government and other
resources to ensure security and safety measures authorized agencies to provide the necessary tech-
especially if targeting women and children. How nical knowledge and expertise. COVID-19, for
to acquire such resources without external example, required WHO, CDC, and other interna-
funding and expertise could be a major challenge tional health organizations to provide information
for SBCC programs. about the disease and the recommended preven-
The participatory approach in SBCC is crucial tive measures.
for long-term change and the sustainability that is SBCC programs must embrace the role of
associated with community ownership. Commu- evidence-based communication that is based on
nity engagement is also critical in identifying the formative research and measurable objectives to
critical needs as well as realistic solutions for their attain the overarching goals. This entails system-
communities. However, SBCC interventions have atic program evaluation to measure both short-
been criticized for a lack of clear goals and sus- term and long-term outcomes. Formative research
tainability strategies. Agunga (1999), for exam- provides the baseline for project planning while
ple, criticized development programs for lack of summative evaluation determines the attainment
planning, which leads to haphazard development of goals and objectives. Although program eval-
and dissemination of communication materials as uation models exist, SBCC has been criticized for
in the IEC programs. Although there are strategic lacking strong tools and effective evaluation
communication models used in other disciplines, methods to demonstrate the contribution of pro-
social and development communication programs grams to the expected outcomes (Christofides
have only recently accepted the term “strategic,” et al. 2013).
which is equated to public relations (PR) and other Identifying communication strategies for
persuasive fields including social marketing. In an SBCC interventions also requires exploring the
agricultural communication manual, for example, role of digital media as part of the engagement
FAO indicated that agricultural communication is process. In the digital age, SBCC must also
“NOT” public relations, which implies a lack of explore the role of social media and online com-
understanding of the role of the strategic commu- munities in knowledge creation and sharing.
nication process in SBCC. Sitton et al. (2005), Online health communities, for example, provide
however, noted the need for PR proficiencies in opportunities for people to create and share con-
agricultural communication programs that include tent across topics, borders, and cultures, even as
creative skills, strategic planning, audience more organizations transition to eHealth as a key
communication strategy to provide facts about
Social and Behavior Change Communication 7

health issues and to motivate behavior change. environmental professionals at Duke University.
SBCC programs must also focus on the targeted While these courses and programs are at the grad-
audience’s information-seeking communication uate level, individual core or elective courses in
behaviors, especially their use of digital devices. SBCC are likely to be found in undergraduate
In Ebola prevention, for example, the use of curricula, for example, the SBCC in Population
WhatsApp was important in message sharing and Health course offered by the University of
and the eventual prevention of diseases in the Cape Coast in Ghana.
West African region. Similarly, the type of infor- SBCC academic training is offered mainly in
mation needed in preventing the Chikungunya communication, social sciences, public health,
outbreak in Brazil indicated the importance of population and health, health sciences, and envi-
understanding the communication needs and ronment disciplines, whereas government and
practices of the targeted audience, both of which nonprofit agencies offer nonacademic profes-
are emphasized in strategic communication sional training for the practitioners. The Ideal
approaches. However, with the increased use of Public Health and Development Consultancy
social media platforms for content creation and (IPHDC) offers an online self-paced certificate
sharing, SBCC programs must address mis- course in SBCC in association with ReliefWeb,
information, disinformation, and malinformation the humanitarian information service of the
that spread rapidly and, in the case of health and United Nations Office for the Coordination of
other risks, could have detrimental consequences. Humanitarian Affairs (OCHA). The SBCC field
has also benefited from renowned and well-
established global centers that focus on behavior
SBCC Education, Networks, and Summits change communication. The Johns Hopkins
University’s Center for Communication Programs
With the evolution of SBCC, various universities established in 1988 as part of the University’s
have provided education and training either at the Bloomberg School of Public Health focuses on
graduate master’s level or short professional cer- reproductive health and family planning, HIV and
tificate programs for emerging SBCC practi- AIDS, and malaria (Poitrow et al. 1999). The
tioners. The curriculum tends to cover the World Association of Christian Communication
theoretical foundations of SBCC, models for (WACC), the global ecumenical non-
intervention planning, and research for monitor- governmental organization (NGO), formed in
ing and evaluation. Examples of these programs 1968, focuses on human rights in the advance-
include a master’s degree in Communication for ment of peace and justice and has supported var-
Social and Behavior Change at the Caribbean ious SBCC projects that embrace the role of
School of Media and Communication communication in achieving social change
(CARIMAC), The University of the West Indies (Thomas 2015).
in Jamaica which was established in 2004; a mas- Besides training, organizations have emerged
ter’s degree in Behavior Change Communication over the years as resources for SBCC practitioners
for Health at the Muhimbili University of Health globally. For example, the Communication for
and Allied Sciences in Dar es Salaam; a certificate Social Change Consortium, which was formed
program in Communication for Social Change at in 2003 in the USA to expand special grant pro-
the School of Communication and Arts’ Center gramming initiated in 1997 by the Rockefeller
for Communication and Social Change at the Uni- Foundation, has evolved into a network of inter-
versity of Queensland in Australia’s Faculty of national aid organizations, NGOs, and universi-
Humanities and Social Sciences; and professional ties globally (Gumucio-Dagron and Tufte 2006).
short courses in Behavior Change and Communi- The Communication Initiative Network (www.
cation with its focus on health science at AMREF comminit.com) established in 1998 is an online
International University in Kenya; as well as a resource and knowledge-sharing platform for
communication for behavior change course for SBCC practitioners (The Communication
8 Social and Behavior Change Communication

Initiative Network | Convening the Communica- Action, 6(19300), 67–74. https://doi.org/10.3402/gha.

tion and Media Development, Social and Behav- v6i0.19300.
Dutta, M. J. (2007). Communicating about culture and
ior Change Community 2023). Similarly, The health: Theorizing culture-centered and cultural sensi-
Soul City SBCC Institute was established in tivity approaches. Communication Theory, 17(3),
1992 as a South African NGO to address mother 304–328. https://doi.org/10.1111/j.1468-2885.2007.
and child health and utilized edutainment strate- 00297.x.
Edutainment, Musical and Media Production. (n.d.). The
gies including television and radio drama serials Ashe Company. Retrieved January 31, 2023, from
to promote change (Goldstein et al. 2004). https://theashecompany.org/services/
The growth of SBCC has been underscored by Goldstein, S., Japhet, G., Usdin, S., & Scheepers,
the staging of global events targeting practitioners E. (2004). Soul City: A sustainable edutainment vehicle
facilitating social change. Health Promotion Journal of
and researchers. The first international SBCC Australia, 15(2), 114–120. https://doi.org/10.1071/
summit was held in 2016 in Addis Ababa, Ethio- HE04114.
pia, with over 750 SBCC professionals Gumucio-Dagron, A., & Tufte, T. (Eds.). (2006). Commu-
representing 50 countries. Subsequent summits nication for social change anthology: Historical and
contemporary readings. Communication for Social
have been held in Nusa Dua, Indonesia, in 2016 Change Consortium.
and Marrakech, Morocco, in 2022. Sustaining Jesus, E. A. D., Albarado, Á. J., Andrade, N. F., Costa,
these opportunities for institutionalizing SBCC L. D. D., Alvarenga, J. D. P. O., Sousa, M. F. D., &
augurs well for the future use of communication Mendonça, A. V. M. (2021). Communication in pre-
vention and control to dengue, chikungunya, and zika:
as part of the solution to address social issues. A panorama analyzed with the Brazilian population.
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Cross-References Kim, Y. C., & Ball-Rokeach, S. J. (2006). Community
storytelling network, neighborhood context, and civic
engagement: A multilevel approach. Human Commu-
▶ Entertainment Education nication Research, 32(4), 411–439. https://doi.org/10.
▶ Formative Evaluation 1111/j.1468-2958.2006.00282.x.
▶ Storytelling McGuire, J. W. (2012). McGuire’s classic input–output
framework for constructing persuasive messages. In
▶ Summative Evaluation R. E. Rice & C. K. Atkin (Eds.), Public communication
campaigns (pp. 133–146). Sage.
Murphy, E. M., Greene, M. E., Mihailovic, A., & Olupot-
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