Behaviour change communication: what works in campaigns

Behaviour change communication uses planned messages, conversations and media to help people adopt a practice: vaccinating a child, washing hands, using a health service. Today most agencies talk about social and behaviour change communication (SBCC), because individual choices depend heavily on families, communities and services.

UNICEF describes social and behaviour change (SBC) as a set of approaches and strategies that promote positive and measurable changes, and lists strategic communication and SBCC alongside community engagement, service improvements, supportive public policies, systems strengthening and applied behavioural science.¹ Its guidance is direct about the limits of messaging: communication and social mobilisation remain central, but "we need more".¹

Many campaigns begin with a slogan. Effective ones begin with a precise behaviour, a defined audience and a diagnosis of what stands in the way of the people you want to reach. UNICEF's programme guidance organises planning into diagnose, define success and design, in that order.¹

Its Behavioural Drivers Model groups the levers of change into three families: psychological, social and environmental.¹ That matters for communicators. If mothers already know vaccines protect children but the clinic is far away, more awareness messages will not help. If a practice is resisted because neighbours disapprove, the campaign needs to work on social norms, which UNICEF notes can play a huge role in personal decision-making.¹

• Which exact behaviour do we want, by whom, and how often?
• What prevents it today: knowledge, beliefs, norms, access or cost?
• Which of those barriers can communication actually change?

The most consistent lesson in the research is that communication cannot replace access. A review of mass media health campaigns in The Lancet concluded that campaigns can produce positive changes or prevent negative changes in health behaviours across large populations, and that results depend on factors such as the concurrent availability of required services and products, community-based programmes and supportive policies.²

The same review found that media campaigns without organised screening services produced little or no detectable increase in cervical cancer screening.² The WHO strategic communications framework makes the same point from the audience's side: to be actionable, communication should tell people what to do and point to steps they can realistically take.³ Before you brief a creative team, confirm that the clinic, the product or the service is ready.

Rwanda offers a useful model of national coordination. The Ministry of Health, through the Rwanda Biomedical Centre, and the Ministry of Gender and Family Promotion launched a National Social Behaviour Change Communication Strategy for 2018 to 2024 covering early childhood development, nutrition and water, sanitation and hygiene.⁴

The Social and Behaviour Change Strategy for Routine Immunisation in Rwanda 2021–2026 segments audiences into primary groups (parents of young children and health workers), secondary groups (family, community and religious leaders) and tertiary groups such as policy makers, media and the private sector.⁵ Its formative research found that the most preferred channel was interpersonal communication through community health workers and health facility staff, supported by radio, mobile phones, Umuganda, social media and community groups.⁵ For a health communication campaign in Rwanda, a film or radio spot is often strongest when it gives community health workers something to discuss.

Pretesting means bringing together members of the priority audience to react to draft materials before final production. The Compass for SBC guide explains that it increases the impact of SBCC materials by checking whether what has been designed suits the audience, and that even a small, well-designed pretest is useful.⁶ Messages, storyboards, campaign names, translated text and interpersonal activities can all be pretested.⁶

Participants should match the priority audience and should not have helped develop the materials.⁶ Rwanda's immunisation strategy requires materials to be pretested and modified based on the feedback.⁵ In Rwanda, the national Compass for SBC, run by the Rwanda Health Communication Centre at RBC, also offers an online process for approval of health materials and messages, so plan time for review.⁷

WHO's framework asks that health communication be accessible, actionable, credible and trusted, relevant, timely and understandable, and recommends plain language, real stories and visuals to help people grasp risks.³ Relevance comes from connecting messages to people's own experiences, families and communities.³ This is where documentary film and photography earn their place: a recognisable neighbour explaining a decision is often more persuasive than a statistic.

Duration matters too. The Lancet review notes that withdrawal of media campaigns has been associated with a decline in beneficial effects, and calls for longer, better-funded campaigns to achieve adequate exposure.² It also warns that campaign messages can fall short and even backfire, which is another reason to test and monitor.² A short burst of content around a launch event rarely changes an ongoing habit.

Views and impressions tell you a message was seen, not that anything changed. UNICEF recommends routine monitoring during implementation to examine fidelity and identify gaps, alongside evaluation of results.¹ Rwanda's immunisation strategy combines implementation monitoring with behavioural monitoring for early signs of change, and plans a follow-up knowledge, attitudes and practices study against an earlier baseline.⁵ It also acknowledges that baselines were not available for every indicator, a common gap worth closing before launch.⁵

In our own practice, we agree two or three behavioural indicators with partners at the start, and we keep a record of how content is used by health workers, partners and media. That makes it easier to see which materials actually supported the change.

• Name one specific behaviour and one priority audience
• Diagnose the psychological, social and environmental barriers
• Confirm the service or product is available before launch
• Map secondary audiences such as leaders and health workers
• Choose channels people trust, including interpersonal ones
• Pretest messages and materials with the priority audience
• Plan for sustained exposure, not a one-off burst
• Set a baseline and track behavioural indicators