The impact of social and behaviour change communication intervention on nutrition outcomes in Mangwe district

The impact of social and behaviour change communication intervention on nutrition outcomes in Mangwe district: Amalima
By
Promise Mguni
R145342R
2245995133350
BSc (Hons) in Nutrition Student
Institute of Food, Nutrition and Family Sciences
Faculty of Science
Supervisor:
Dr TM Matsungo
Co: Supervisor:
Dr LK Nyanga
UNIVERSITY OF ZIMBABWE
Mt. Pleasant, Harare
January 2018
Dedications
declaration
acknowledgements

AbstractBackground: Health intervention programs by None Governmental Organizations (NGO) are being implemented throughout the world, special in Africa in trying to curb stunting and other malnutrition conditions. Mass feeding of these affected communities can to alone reduce malnutrition and stunting hence the need for educational and behaviour change approaches. Social behaviour change communication (SBCC) is being incorporated by AMALIMA program instead of Information, Education and Communication (IEC) in addressing stunting promoting good health nutrition practices, the SBCC approach is said to promote sustainability in communities it is being implemented in. However little is known about SBCC and there is need to collect more data to see how this concept is impacting nutritional outcomes in the communities it is being administered in and to evaluate the areas that need to be improved in executing it perfectly.

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Broad Objective: To investigate the impact of nutrition SBCC on nutrition practices of Pregnant and Lactating Women (PLW).
Specific Objectives
1.To determine the percentage of women who received antenatal care during pregnancy
2.To determine the level of adoption of exclusive breastfeeding in beneficiaries of the program
3.To investigate the complementary feeding practices of the program beneficiaries

Table of Contents
Contents
TOC o “1-3” h z u Dedications PAGEREF _Toc514103294 h ideclaration PAGEREF _Toc514103295 h iiacknowledgements PAGEREF _Toc514103296 h iiiAbstract PAGEREF _Toc514103297 h ivTable of Contents PAGEREF _Toc514103298 h vList of Acronyms and Abbreviations PAGEREF _Toc514103299 h viList of Tables PAGEREF _Toc514103300 h viiList of Figures PAGEREF _Toc514103301 h viii1.1.Introduction PAGEREF _Toc514103302 h – 1 -1.2.Background and justification PAGEREF _Toc514103303 h – 2 -2.1.Introduction PAGEREF _Toc514103304 h – 5 -2.2.SBCC Media PAGEREF _Toc514103305 h – 6 -2.1.1Social media and SBCC PAGEREF _Toc514103306 h – 7 -2.3SBCC theories PAGEREF _Toc514103307 h – 7 -2.3.1The Health Model (HBM) PAGEREF _Toc514103308 h – 8 -2.3.2Trans theoretical model (TTM) PAGEREF _Toc514103309 h – 9 -2.3.3Diffusion of Innovation Theory PAGEREF _Toc514103310 h – 9 -2.3.4Social Cognitive Theory (SCT) PAGEREF _Toc514103311 h – 10 -3.Methodology PAGEREF _Toc514103312 h – 15 -3.1Study Setting PAGEREF _Toc514103313 h – 15 -Results PAGEREF _Toc514103314 h – 17 –

List of Acronyms and Abbreviations
List of Tables

List of Figures
TOC h z c “Figure” Figure 2.3.1: The Health Belief Model (adopted from Glanz et al, 2002) PAGEREF _Toc514102818 h – 9 -Figure 2.3.2: Diffusion of Innovation Adopter Categories (Adopted from (Jones et al., 2015)) PAGEREF _Toc514102819 h – 10 -Figure 2.3.3: The Social Cognitive Model ( adopted from Young et al., 2014) PAGEREF _Toc514102820 h – 11 –
Chapter 1
IntroductionUnder-nutrition during pregnancy and lactation is a critical determinant of maternal, neonatal, and child health outcomes. Maternal under-nutrition is associated with an increased risk of maternal mortality, and both maternal stunting and wasting are associated with full term and preterm births of children small for gestational age (SGA) ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “https://doi.org/10.1016/S0140-6736(13)60937-X”, “ISSN” : “0140-6736”, “author” : { “dropping-particle” : “”, “family” : “Black”, “given” : “Robert E”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Victora”, “given” : “Cesar G”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Walker”, “given” : “Susan P”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bhutta”, “given” : “Zulfiqar A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Christian”, “given” : “Parul”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Onis”, “given” : “Mercedes”, “non-dropping-particle” : “de”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ezzati”, “given” : “Majid”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Grantham-McGregor”, “given” : “Sally”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Katz”, “given” : “Joanne”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Martorell”, “given” : “Reynaldo”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Uauy”, “given” : “Ricardo”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “The Lancet”, “id” : “ITEM-1”, “issue” : “9890”, “issued” : { “date-parts” : “2013” }, “page” : “427-451”, “title” : “Maternal and child undernutrition and overweight in low-income and middle-income countries”, “type” : “article-journal”, “volume” : “382” }, “uris” : “http://www.mendeley.com/documents/?uuid=bd76292a-f284-4f58-918f-bb0959886ac7” } , “mendeley” : { “formattedCitation” : “(Black <i>et al.</i>, 2013)”, “plainTextFormattedCitation” : “(Black et al., 2013)”, “previouslyFormattedCitation” : “(Black <i>et al.</i>, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Black et al., 2013) and low birth weight. Children born SGA are more likely to become stunted children and adults, which, for women, can place them at increased risk for delivery complications, morbidity, and mortality over time ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “https://doi.org/10.1016/S0140-6736(13)60996-4”, “ISSN” : “0140-6736”, “author” : { “dropping-particle” : “”, “family” : “Bhutta”, “given” : “Zulfiqar A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Das”, “given” : “Jai K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Rizvi”, “given” : “Arjumand”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gaffey”, “given” : “Michelle F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Walker”, “given” : “Neff”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Horton”, “given” : “Susan”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Webb”, “given” : “Patrick”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Lartey”, “given” : “Anna”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Black”, “given” : “Robert E”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “The Lancet”, “id” : “ITEM-1”, “issue” : “9890”, “issued” : { “date-parts” : “2013” }, “page” : “452-477”, “title” : “Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?”, “type” : “article-journal”, “volume” : “382” }, “uris” : “http://www.mendeley.com/documents/?uuid=000e67dd-7bd8-432b-a1d1-2fa2ac49a482” } , “mendeley” : { “formattedCitation” : “(Bhutta <i>et al.</i>, 2013)”, “plainTextFormattedCitation” : “(Bhutta et al., 2013)”, “previouslyFormattedCitation” : “(Bhutta <i>et al.</i>, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Bhutta et al., 2013). Low birth weight has been shown to cost society in increased infant mortality, lost wages and productivity in adulthood, increased stunting and related illness, and increased rates of non-communicable disease (NCDs) in adulthood.
Social Behaviour Change Communication can directly achieve many positive nutrition behaviour and social changes, but it cannot achieve all. For example, well-designed SBCC campaigns promoting Vitamin A can successfully increase demand for these supplements. Yet, without functioning supply chains and sufficient stocks in place in the facilities or communities, the desired levels of use of Vitamin A cannot be attained no matter how high the demand. Undernutrition during pregnancy and lactation is a critical determinant of maternal, neonatal, and child health outcomes. Improving dietary adequacy during pregnancy and lactation is important to help women accommodate their nutritional requirements as well as their children’s requirements during intrauterine development and while breastfeeding ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/1475-2891-12-28”, “ISSN” : “1475-2891”, “abstract” : “Lactating mothers from low-income settings are considered as a nutritionally vulnerable group. Due to the nursing process, mothers are subjected to nutritional stresses. Frequent pregnancies followed by lactation increase the health risk of mothers resulting in a high maternal mortality.”, “author” : { “dropping-particle” : “”, “family” : “Haileslassie”, “given” : “Kiday”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Mulugeta”, “given” : “Afework”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Girma”, “given” : “Meron”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Nutrition Journal”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2013” }, “page” : “28”, “title” : “Feeding practices, nutritional status and associated factors of lactating women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia”, “type” : “article-journal”, “volume” : “12” }, “uris” : “http://www.mendeley.com/documents/?uuid=01c56ed1-60ac-43ff-a3e9-f3c9e99107d8” } , “mendeley” : { “formattedCitation” : “(Haileslassie, Mulugeta and Girma, 2013)”, “plainTextFormattedCitation” : “(Haileslassie, Mulugeta and Girma, 2013)”, “previouslyFormattedCitation” : “(Haileslassie, Mulugeta and Girma, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Haileslassie, Mulugeta and Girma, 2013).

Evidence suggests that simply increasing knowledge and awareness of good nutrition practices rarely leads to sustained behaviour change, nor is sustained change in nutrition behaviour likely to be achieved through a single activity (WHO, 2015). Several specific behaviours or practices impact nutritional status during the critical first 1,000 days (pregnancy to age two), while complex, contextual determinants also influence individual decisions to consider, test, adopt and sustain a given behaviour or practice. The field of SBCC is a collection of approaches and tools informed by behavioural theories and used to design public health interventions (FHI, 2018). Most health interventions nowadays usually include an aspect of social and behaviour change communication instead of the traditional Information, Education and Communication (IEC) (IHBP, 2013). The SBCC approach mostly used, and the only one used without other communication interventions, is interpersonal communication. While media and community/social mobilization are used, they were always used with at least one other communication approach. Very little has been done to compare the effect of differences in the delivery science, particularly when implemented at scale.

Background and justificationHealth intervention programs by None Governmental Organizations (NGO) are being implemented throughout the world, special in Africa in trying to curb stunting and other malnutrition conditions. Mass feeding of these affected communities can to alone reduce malnutrition and stunting hence the need for educational and behavior change approaches. Social behavior change communication (SBCC) is being incorporated by AMALIMA program instead of Information, Education and Communication (IEC) in addressing stunting promoting good health nutrition practices, the SBCC approach is said to promote sustainability in communities it is being implemented in. However little is known about SBCC and there is need to collect more data to see how this concept is impacting nutritional outcomes in the communities it is being administered in and to evaluate the areas that need to be improved in executing it perfectly.

References
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Adewuyi, E. O. and Adefemi, K. (2016) ‘Behavior Change Communication Using Social Media: A Review’, International Journal of Communication and Health, 9, pp. 109–116. Available at: http://communicationandhealth.ro/upload/number9/EMMANUEL-O-ADEWUYI.pdf.

Bandura, A. (1997) Self-efficacy?: the exercise of control. Worth Publishers. Available at: https://books.google.co.zw/books/about/Self_Efficacy.html?id=eJ-PN9g_o-EC;redir_esc=y (Accessed: 13 May 2018).

Bhutta, Z. A. et al. (2013) ‘Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?’, The Lancet, 382(9890), pp. 452–477. doi: https://doi.org/10.1016/S0140-6736(13)60996-4.

Black, R. E. et al. (2013) ‘Maternal and child undernutrition and overweight in low-income and middle-income countries’, The Lancet, 382(9890), pp. 427–451. doi: https://doi.org/10.1016/S0140-6736(13)60937-X.

Free, C. et al. (2013) ‘The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review’, PLoS Medicine. Edited by T. Cornford. Public Library of Science, 10(1), p. e1001362. doi: 10.1371/journal.pmed.1001362.

Haileslassie, K., Mulugeta, A. and Girma, M. (2013) ‘Feeding practices, nutritional status and associated factors of lactating women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia’, Nutrition Journal, 12(1), p. 28. doi: 10.1186/1475-2891-12-28.

Jones, C. L. et al. (2015) ‘The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.’, Health communication. NIH Public Access, 30(6), pp. 566–76. doi: 10.1080/10410236.2013.873363.

Koenker, H. et al. (2014) ‘Strategic roles for behaviour change communication in a changing malaria landscape’, Malaria Journal. BioMed Central, 13, p. 1. doi: 10.1186/1475-2875-13-1.

Korda, H. and Itani, Z. (2013) ‘Harnessing Social Media for Health Promotion and Behavior Change’, Health Promotion Practice. SAGE PublicationsSage CA: Los Angeles, CA, 14(1), pp. 15–23. doi: 10.1177/1524839911405850.

Lamstein, S. et al. (2014) ‘Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia Findings from a Systematic Literature Review RECOMMENDED CITATION Evidence of Effective Approaches to Social and Behavior Change C’. Available at: https://www.spring-nutrition.org/sites/default/files/publications/series/spring_sbcc_lit_review.pdf (Accessed: 13 May 2018).

Leslie, J. et al. (2015) ‘Effects of Behaviour Change Communication Strategies Embedded in Social Marketing Programs on Health Behaviours and Related Health and Welfare Outcomes in Low and Middle Income Countries’. Available at: http://campbellcollaboration.org/lib/project/283/.

Poorman, E. et al. (2014) ‘Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population?’, Archives of Public Health. BioMed Central, 72(1), p. 13. doi: 10.1186/2049-3258-72-13.

Portsmouth, L., Coyle, J. and Trede, F. (2013) ‘Working as a member of a health team’, Communicating in the health sciences. Oxford Press, pp. 271–279. Available at: https://espace.curtin.edu.au/handle/20.500.11937/30495 (Accessed: 13 May 2018).

Portsmouth, L., Trede, F. and Olsen, M. (2013) ‘Communicating with the community about health’, Communicating in the health sciences. Oxford University Press, pp. 249–259. Available at: https://espace.curtin.edu.au/handle/20.500.11937/34321 (Accessed: 13 May 2018).

Sreekumaran, N. et al. (2016) ‘Effectiveness of Behaviour Change Communication Intervention in Delivering Health Messages on Antenatal Care for Improving Maternal and Child Health Indicators in a Limited Literacy Setting: An Evidence Summary of Syste,atic Reviews’, (August), pp. 1–45.

The Manoff Group (2012) ‘Defining Social and Behavior Change Communicacion (SBCC) and Other Essential Health Communication Terms’, pp. 1–4. Available at: http://manoffgroup.com/documents/DefiningSBCC.pdf.

Thompson, C. et al. (2015) Thompson et al 2014.

WHO (2010) ‘Indicators for assessing infant and young child feeding practices.’, Part 3 Country Profiles, pp. 1–47. doi: ISBN 978 92 4 159975 7.

Young, M. D. et al. (2014) ‘Social cognitive theory and physical activity: A systematic review and meta-analysis’, Obesity Reviews, 15(12), pp. 983–995. doi: 10.1111/obr.12225.

Chapter two: Literature Review
IntroductionOne of the most cost effective ways of targeting the issues of Maternal and Child Health (MCH) is through Social and Behaviour Change Communication (SBCC). SBCC is part of the broader sub-discipline of health communication – the study and application of communication strategies for promoting positive health outcomes ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Sreekumaran”, “given” : “Nair”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sarak”, “given” : “S”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Nelson”, “given” : “Hannah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trupti”, “given” : “Darak”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “August”, “issued” : { “date-parts” : “2016” }, “page” : “1-45”, “title” : “Effectiveness of Behaviour Change Communication Intervention in Delivering Health Messages on Antenatal Care for Improving Maternal and Child Health Indicators in a Limited Literacy Setting: An Evidence Summary of Syste,atic Reviews”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6e5f40ab-a0a4-44e3-8f6e-ecde45eaf3e6” } , “mendeley” : { “formattedCitation” : “(Sreekumaran <i>et al.</i>, 2016)”, “plainTextFormattedCitation” : “(Sreekumaran et al., 2016)”, “previouslyFormattedCitation” : “(Sreekumaran <i>et al.</i>, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Sreekumaran et al., 2016). According to Sreekumaran et al (2016), SBCC is the whole range of procedures and techniques used to inspire positive health outcomes by making planned and prearranged usage of communication to strengthen health seeking behaviours through health literacy, and can be either focused at the community or individual level. SBCC is defined as “a research-based consultative process of addressing knowledge, attitudes and practices through identifying, analysing and segmenting audiences and participants in programmes by providing them with relevant information and motivation through well-defined strategies, using an audience-appropriate mix of interpersonal, group and mass-media channels, including participatory methods” ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Sreekumaran”, “given” : “Nair”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sarak”, “given” : “S”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Nelson”, “given” : “Hannah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trupti”, “given” : “Darak”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “August”, “issued” : { “date-parts” : “2016” }, “page” : “1-45”, “title” : “Effectiveness of Behaviour Change Communication Intervention in Delivering Health Messages on Antenatal Care for Improving Maternal and Child Health Indicators in a Limited Literacy Setting: An Evidence Summary of Syste,atic Reviews”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6e5f40ab-a0a4-44e3-8f6e-ecde45eaf3e6” } , “mendeley” : { “formattedCitation” : “(Sreekumaran <i>et al.</i>, 2016)”, “plainTextFormattedCitation” : “(Sreekumaran et al., 2016)”, “previouslyFormattedCitation” : “(Sreekumaran <i>et al.</i>, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Sreekumaran et al., 2016).

With components ranging from interpersonal communication between a community health worker and her client to multi-level mass media campaigns, evidence-based and theory-driven BCC interventions are an fundamental part of all types of health promotion and disease deterrence, and have been shown to meaningfully improve behaviours, notably in the areas of family planning and HIV prevention, but also in hygiene and sanitation, nutrition, and other disease areas ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/1475-2875-13-1”, “ISSN” : “1475-2875”, “abstract” : “Strong evidence suggests that quality strategic behaviour change communication (BCC) can improve malaria prevention and treatment behaviours. As progress is made towards malaria elimination, BCC becomes an even more important tool. BCC can be used 1) to reach populations who remain at risk as transmission dynamics change (e.g. mobile populations), 2) to facilitate identification of people with asymptomatic infections and their compliance with treatment, 3) to inform communities of the optimal timing of malaria control interventions, and 4) to explain changing diagnostic concerns (e.g. increasing false negatives as parasite density and multiplicity of infections fall) and treatment guidelines. The purpose of this commentary is to highlight the benefits and value for money that BCC brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change. “, “author” : { “dropping-particle” : “”, “family” : “Koenker”, “given” : “Hannah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Keating”, “given” : “Joseph”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Alilio”, “given” : “Martin”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Acosta”, “given” : “Angela”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Lynch”, “given” : “Matthew”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Nafo-Traore”, “given” : “Fatoumata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Malaria Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2014”, “1”, “2” }, “page” : “1”, “publisher” : “BioMed Central”, “title” : “Strategic roles for behaviour change communication in a changing malaria landscape”, “type” : “article-journal”, “volume” : “13” }, “uris” : “http://www.mendeley.com/documents/?uuid=96cc79ff-1a04-4fd0-8665-721a5658c408” } , “mendeley” : { “formattedCitation” : “(Koenker <i>et al.</i>, 2014)”, “plainTextFormattedCitation” : “(Koenker et al., 2014)”, “previouslyFormattedCitation” : “(Koenker <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Koenker et al., 2014). Strategically targeting messages and approaches allows SBCC to focus on specific individuals, household, or communities to maximize results of health interventions. This results-based approach to control and prevention has been used in a variety of settings to assess or change behaviour related to health, and strong evidence suggests that quality BCC can improve malaria prevention and treatment behaviours SBCC occupies a strategic position in health promotion, as research has shown that theory driven and evidence-based SBCC interventions are the hallmarks of successful health promotion programs ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1177/1524839911405850”, “ISSN” : “1524-8399”, “abstract” : “Rapid and innovative advances in participative Internet communications, referred to as u201csocial media,u201d offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or identified. People of all demographics are adopting these technologies whether on their computers or through mobile devices, and they are increasingly using these social media for health-related issues. Although social media have considerable potential as tools for health promotion and education, these media, like traditional health promotion media, require careful application and may not always achieve their desired outcomes. This article summarizes current evidence and understanding of using social media for health promotion. 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SBCC can be directed at different levels of communities such as local, regional, and national levels, through wide varieties of mechanisms delivered by different modes of networks and forms ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Leslie”, “given” : “Jackie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Riboli-Sasco”, “given” : “Eva Fleur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Felix”, “given” : “Lambert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Car”, “given” : “Josip”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Head”, “given” : “Roy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Knowles”, “given” : “Sarah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gunn”, “given” : “Laura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “title” : “Effects of Behaviour Change Communication Strategies Embedded in Social Marketing Programs on Health Behaviours and Related Health and Welfare Outcomes in Low and Middle Income Countries”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=8d45ba99-d78e-4084-b9c8-04256d2a74e2” } , “mendeley” : { “formattedCitation” : “(Leslie <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Leslie et al., 2015)”, “previouslyFormattedCitation” : “(Leslie <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Leslie et al., 2015). SBCC can be used for community mobilization, nutrition and health education as well as different public outreach programs ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Leslie”, “given” : “Jackie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Riboli-Sasco”, “given” : “Eva Fleur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Felix”, “given” : “Lambert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Car”, “given” : “Josip”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Head”, “given” : “Roy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Knowles”, “given” : “Sarah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gunn”, “given” : “Laura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “title” : “Effects of Behaviour Change Communication Strategies Embedded in Social Marketing Programs on Health Behaviours and Related Health and Welfare Outcomes in Low and Middle Income Countries”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=8d45ba99-d78e-4084-b9c8-04256d2a74e2” } , “mendeley” : { “formattedCitation” : “(Leslie <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Leslie et al., 2015)”, “previouslyFormattedCitation” : “(Leslie <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Leslie et al., 2015). Moreover, the understanding that health behavior/status is an interplay of biological, social and environmental factors supports the need for SBCC interventions ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/1475-2875-13-1”, “ISSN” : “1475-2875”, “abstract” : “Strong evidence suggests that quality strategic behaviour change communication (BCC) can improve malaria prevention and treatment behaviours. As progress is made towards malaria elimination, BCC becomes an even more important tool. BCC can be used 1) to reach populations who remain at risk as transmission dynamics change (e.g. mobile populations), 2) to facilitate identification of people with asymptomatic infections and their compliance with treatment, 3) to inform communities of the optimal timing of malaria control interventions, and 4) to explain changing diagnostic concerns (e.g. increasing false negatives as parasite density and multiplicity of infections fall) and treatment guidelines. 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Using the most fundamental and powerful human interaction, communication, SBCC can positively influence the social components of health and wellbeing. SBCC has been noted to be effective in areas such as nutrition, hygiene and sanitation, and in many other diseases.

SBCC MediaSBCC in public health includes interventions that focus on communicating health messages to individuals, households or communities through various mediums and in ways that can tangibly impact health behaviour. It can be delivered in a diversity of ways to individuals and communities, through Inter Personal Communication (IPC)/counselling or group discussions; mid-media or edutainment such as songs, folk dances, street shows, dramas, and the multifarious use of the fine and performing arts, and, mass media including print media such as newspapers, posters, flyers, leaflets, booklets etc., electronic media including radio, television and online/digital platforms and the Internet ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “Health education can be defined as any combination of learning experiences designed to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes. 1 Specifically focused on the communication aspect, Information, Education and Communication (IEC) was developed in the early 1970s, when the use of mass media proved to be a useful tool in disseminating health information. IEC can range from didactic one-way communication to entertaining methods. It can utilize a wide range of media channels and materials. Regardless of the approach, IEC is usually implemented by a public health or medical expert who gives recommendations to an audience. Fundamentally, the IEC approach assumes that people will follow health advice when they are provided with the ” right ” information. Introducing the health consumer’s point of view: Social Marketing Although IEC improved many aspects of communication, and evidence showed that it could increase knowledge and improve attitudes, it often did not result in behavior change because topics were largely limited to what health experts considered to be important and were conveyed from their perspective. Therefore, in many cases health outcomes did not change. In the mid-1970s, health communication practitioners began to consider lessons from the commercial marketing sector, where consumer analysis proved to be the most critical aspect of successfully promoting products to target audiences. From this, Social Marketing was created to apply commercial marketing approaches to promoting products, services or behaviors that would improve health. Social marketing uses research to bring the consumer perspective to the forefront, and uses the client’s (consumer’s) point of view to define a social problem and consequently the marketing and media mix that can be used to respond to it. Social marketing also recognizes that communication (i.e., promotion) is only one element of the marketing mix; and that products and behaviors, placement, and pricing could be equally important to achieving objectives.”, “author” : { “dropping-particle” : “”, “family” : “The Manoff Group”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “page” : “1-4”, “title” : “Defining Social and Behavior Change Communicacion (SBCC) and Other Essential Health Communication Terms”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=e3704905-ebcf-4b14-9d43-dcb960d03e99” } , “mendeley” : { “formattedCitation” : “(The Manoff Group, 2012)”, “plainTextFormattedCitation” : “(The Manoff Group, 2012)”, “previouslyFormattedCitation” : “(The Manoff Group, 2012)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(The Manoff Group, 2012).
A major channel for SBCC in modern human society is via the digital or electronic mode such as mobile phones (m-health), internet, social media, blogs, chat rooms (e-health), video games, health apps (ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Leslie”, “given” : “Jackie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Riboli-Sasco”, “given” : “Eva Fleur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Felix”, “given” : “Lambert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Car”, “given” : “Josip”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Head”, “given” : “Roy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Knowles”, “given” : “Sarah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gunn”, “given” : “Laura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “title” : “Effects of Behaviour Change Communication Strategies Embedded in Social Marketing Programs on Health Behaviours and Related Health and Welfare Outcomes in Low and Middle Income Countries”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=8d45ba99-d78e-4084-b9c8-04256d2a74e2” } , “mendeley” : { “formattedCitation” : “(Leslie <i>et al.</i>, 2015)”, “manualFormatting” : “(Leslie et al., 2015 & “, “plainTextFormattedCitation” : “(Leslie et al., 2015)”, “previouslyFormattedCitation” : “(Leslie <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Leslie et al., 2015 ; ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1371/journal.pmed.1001362”, “ISSN” : “1549-1676”, “abstract” : “Caroline Free and colleagues systematically review a fast-moving field, that of the effectiveness of mobile technology interventions delivered to healthcare consumers, and conclude that high-quality, adequately powered trials of optimized interventions are required to evaluate effects on objective outcomes.”, “author” : { “dropping-particle” : “”, “family” : “Free”, “given” : “Caroline”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Phillips”, “given” : “Gemma”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Galli”, “given” : “Leandro”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Watson”, “given” : “Louise”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Felix”, “given” : “Lambert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Edwards”, “given” : “Phil”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Patel”, “given” : “Vikram”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Haines”, “given” : “Andy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “PLoS Medicine”, “editor” : { “dropping-particle” : “”, “family” : “Cornford”, “given” : “Tony”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2013”, “1”, “15” }, “page” : “e1001362”, “publisher” : “Public Library of Science”, “title” : “The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review”, “type” : “article-journal”, “volume” : “10” }, “uris” : “http://www.mendeley.com/documents/?uuid=d79c4637-3905-3a3a-8dc4-c0030c6f99f6” } , “mendeley” : { “formattedCitation” : “(Free <i>et al.</i>, 2013)”, “manualFormatting” : “Free et al., 2013)”, “plainTextFormattedCitation” : “(Free et al., 2013)”, “previouslyFormattedCitation” : “(Free <i>et al.</i>, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Free et al., 2013)), computer-mediated delivery of individual healthcare advice (for example online physicians), face-to-face educational sessions etc. These newer technologies such as e-platforms and mobile phones can be effectively used for BCC. Lack of accessibility to internet (due to various barriers) restricts the reach and impact of health communication in LMIC’s, but it is evident that the usage of mobile phones is growing phenomenally in these countries too. 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When choosing a media for delivering the SBCC message there are quite a number of issues that should be taken into consideration. These issues include accessibility of the media to the target group, expense as well as relevance of the media to the target group. It is therefore important to conduct a thorough research about the target group before coming up with a SBCC intervention. In order to have an effective communication system, it might be ideal to integrate all the types of media to get full coverage. The issues that cannot be addressed by one media type can be compensated for in other media. This, however, would prove to be very expensive to implemented. Mass media is usually the one used for SBCC because it is cheap but it does not facilitate follow up of the target group so its effectiveness may not be seen. One on one counselling is the best because the health worker would be able to negotiate behaviour change with the target group individually.

Social media and SBCC The invention of the world wide web (www) showed brought new ideas and innovations in terms of communication. A lot of communication platforms that use the internet have been introduced. This communication system has been applied in health promotion and public health education. Extensive research has been done in this area.
SBCC theoriesThis type of communication goes beyond the mere dissemination of perceived necessary health information ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “The emergence of social media introduced a new dimension to communication. The media is increasingly being used in almost every aspect of human endeavor u2013 from marketing and brand promotion to information sharing and relationship building. In view of the participatory nature of social media and its potential for expansive reach of audience, public health professionals are enthusiastic about employing it for communicating behavior change interventions. While evidence indicates the potential benefits of social media tobehavior change communication, this paper, drawing on current literature, emphasizes the need for a strategic deployment of the media. The review highlights some of the challenges of using social media for behavior change communication purposes. 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The paper stresses the need for a two-way communication using social media, working with the audience in developing appropriate communication strategies, and the need for effective evaluation.”, “author” : { “dropping-particle” : “”, “family” : “Adewuyi”, “given” : “Emmanuel Olorunleke”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Adefemi”, “given” : “Kazeem”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Journal of Communication and Health”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2016” }, “page” : “109-116”, “title” : “Behavior Change Communication Using Social Media: A Review”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=f15e3c93-b7fb-4245-9721-67bf14d52d52” } , “mendeley” : { “formattedCitation” : “(Adewuyi and Adefemi, 2016)”, “manualFormatting” : “(Adewuyi and Adefemi, 2016 & “, “plainTextFormattedCitation” : “(Adewuyi and Adefemi, 2016)”, “previouslyFormattedCitation” : “(Adewuyi and Adefemi, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Adewuyi and Adefemi, 2016 & ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Olsen”, “given” : “M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “249-259”, “publisher” : “Oxford University Press”, “title” : “Communicating with the community about health”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=aef67c23-021b-372e-93f5-ca56a5af2402” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “manualFormatting” : “Portsmouth, Trede and Olsen, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Portsmouth, Trede and Olsen, 2013). It is rather a two-way process that involves three cyclical stages – listening, dialoguing and auctioning ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Coyle”, “given” : “J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “271-279”, “publisher” : “Oxford Press”, “title” : “Working as a member of a health team”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6e819e05-4c4d-3a52-a348-ee52774cb9b8” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Portsmouth, Coyle and Trede, 2013). Listening enables health professionals (communicators) to learn about their target audience while dialoguing aims at developing culturally appropriate and easy to understand strategies ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Coyle”, “given” : “J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “271-279”, “publisher” : “Oxford Press”, “title” : “Working as a member of a health team”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6e819e05-4c4d-3a52-a348-ee52774cb9b8” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Portsmouth, Coyle and Trede, 2013). Actioning on the other hand, deals with implementing and maintaining changes often in partnership with other professionals ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Coyle”, “given” : “J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “271-279”, “publisher” : “Oxford Press”, “title” : “Working as a member of a health team”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6e819e05-4c4d-3a52-a348-ee52774cb9b8” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Coyle and Trede, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Portsmouth, Coyle and Trede, 2013). The need for constant evaluation and, hence, adjustment of strategies means these three steps are cyclical and continuous ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Olsen”, “given” : “M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “249-259”, “publisher” : “Oxford University Press”, “title” : “Communicating with the community about health”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=aef67c23-021b-372e-93f5-ca56a5af2402” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Portsmouth, Trede and Olsen, 2013).

Theories and models help explain how behaviour change occurs. Various theories that are the most established in offering theoretical constructs for SBCC are the Social Cognitive Theory, the Health Belief Model, Trans theoretical Model and the Diffusion Theory ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1177/1524839911405850”, “ISSN” : “1524-8399”, “abstract” : “Rapid and innovative advances in participative Internet communications, referred to as u201csocial media,u201d offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or identified. People of all demographics are adopting these technologies whether on their computers or through mobile devices, and they are increasingly using these social media for health-related issues. Although social media have considerable potential as tools for health promotion and education, these media, like traditional health promotion media, require careful application and may not always achieve their desired outcomes. This article summarizes current evidence and understanding of using social media for health promotion. More important, it discusses the need for evaluating the effectiveness of various forms of social media and incorporating outcomes research and theory in the design of health promotion programs for social media.”, “author” : { “dropping-particle” : “”, “family” : “Korda”, “given” : “Holly”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Itani”, “given” : “Zena”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Health Promotion Practice”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2013”, “1”, “10” }, “page” : “15-23”, “publisher” : “SAGE PublicationsSage CA: Los Angeles, CA”, “title” : “Harnessing Social Media for Health Promotion and Behavior Change”, “type” : “article-journal”, “volume” : “14” }, “uris” : “http://www.mendeley.com/documents/?uuid=6af96a60-a803-3dde-b79d-56f3f6cc1c75” } , “mendeley” : { “formattedCitation” : “(Korda and Itani, 2013)”, “plainTextFormattedCitation” : “(Korda and Itani, 2013)”, “previouslyFormattedCitation” : “(Korda and Itani, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Korda and Itani, 2013) among others. The literature (primary studies as well as systematic reviews) suggest that there are efforts to integrate these theories while designing the SBCC intervention.
Recently there are also efforts through systematic reviews to understand the role of theory in promoting positive behaviour change ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Thompson”, “given” : “Catherine”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Biesmeijer”, “given” : “Jacobus”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “R Allnutt”, “given” : “Theodore”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Pietravalle”, “given” : “Stu00e9phane”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Budge”, “given” : “Giles”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2015”, “7”, “20” }, “title” : “Thompson et al 2014”, “type” : “book” }, “uris” : “http://www.mendeley.com/documents/?uuid=32f362af-7c0a-4c0a-918f-aa3dbd7fd3ea” } , “mendeley” : { “formattedCitation” : “(Thompson <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Thompson et al., 2015)”, “previouslyFormattedCitation” : “(Thompson <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Thompson et al., 2015). Some systematic reviews assessing the effectiveness of BCC strategies also have considered if the intervention is based on theories or not. For example, a recent systematic review by ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/2049-3258-72-13”, “ISSN” : “0778-7367”, “abstract” : “BACKGROUND: Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy. METHODS: Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders. RESULTS: Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69). CONCLUSIONS: Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily. “, “author” : { “dropping-particle” : “”, “family” : “Poorman”, “given” : “Elisabeth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gazmararian”, “given” : “Julie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Elon”, “given” : “Lisa”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Parker”, “given” : “Ruth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Archives of Public Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2014”, “5”, “7” }, “page” : “13”, “publisher” : “BioMed Central”, “title” : “Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population?”, “type” : “article-journal”, “volume” : “72” }, “uris” : “http://www.mendeley.com/documents/?uuid=8e919e4c-300d-41ce-a497-2fb1d17d532f” } , “mendeley” : { “formattedCitation” : “(Poorman <i>et al.</i>, 2014)”, “manualFormatting” : “Poorman et al., (2014)”, “plainTextFormattedCitation” : “(Poorman et al., 2014)”, “previouslyFormattedCitation” : “(Poorman <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Poorman et al., (2014) on use of text messaging on maternal and child health suggest that the interventions that are based on established theory of behaviour change and use motivational as opposed to informational language are more likely to be successful ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/2049-3258-72-13”, “ISSN” : “0778-7367”, “abstract” : “BACKGROUND: Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy. METHODS: Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders. RESULTS: Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69). CONCLUSIONS: Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily. “, “author” : { “dropping-particle” : “”, “family” : “Poorman”, “given” : “Elisabeth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gazmararian”, “given” : “Julie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Elon”, “given” : “Lisa”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Parker”, “given” : “Ruth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Archives of Public Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2014”, “5”, “7” }, “page” : “13”, “publisher” : “BioMed Central”, “title” : “Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population?”, “type” : “article-journal”, “volume” : “72” }, “uris” : “http://www.mendeley.com/documents/?uuid=8e919e4c-300d-41ce-a497-2fb1d17d532f” } , “mendeley” : { “formattedCitation” : “(Poorman <i>et al.</i>, 2014)”, “plainTextFormattedCitation” : “(Poorman et al., 2014)”, “previouslyFormattedCitation” : “(Poorman <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Poorman et al., 2014) . This increase in the efforts to understand the role of theories in BCC could also be partly related to the increase in evidence that simply increasing knowledge and awareness about the issues does not necessarily lead to behaviour change and that the behavioural and socio-cultural factors (social determinants) play a significant role in determining behaviour change ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project is a five-year USAID-funded Cooperative Agreement to strengthen global and country efforts to scale up high impact nutrition practices and policies and improve maternal and child nutrition outcomes. SPRING provides state-of-the-art technical support and focuses on the prevention of stunting and maternal and child anemia in the first 1,000 days.”, “author” : { “dropping-particle” : “”, “family” : “Lamstein”, “given” : “S”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Stillman”, “given” : “T”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Koniz-Booher”, “given” : “P”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Aakesson”, “given” : “A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Collaiezzi”, “given” : “B”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Williams”, “given” : “T”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Beall”, “given” : “K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Anson”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2014” }, “title” : “Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia Findings from a Systematic Literature Review RECOMMENDED CITATION Evidence of Effective Approaches to Social and Behavior Change C”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=58b28465-77d8-349a-8bfb-f51bc1e720df” } , “mendeley” : { “formattedCitation” : “(Lamstein <i>et al.</i>, 2014)”, “plainTextFormattedCitation” : “(Lamstein et al., 2014)”, “previouslyFormattedCitation” : “(Lamstein <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Lamstein et al., 2014).

Many interventions for social and behaviour change communication might be based on some theories with or without the explicit knowledge of the people designing the interventions. However, for the purpose of evidence synthesis theory based SBCC intervention can be considered as those interventions that are explicitly designed by using the concepts of one or more theories or models and wherein systematic reviews the authors have clearly mentioned that the interventions are theory based or not while assessing the effectiveness of these interventions ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/2049-3258-72-13”, “ISSN” : “0778-7367”, “abstract” : “BACKGROUND: Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy. METHODS: Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders. RESULTS: Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69). CONCLUSIONS: Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily. “, “author” : { “dropping-particle” : “”, “family” : “Poorman”, “given” : “Elisabeth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gazmararian”, “given” : “Julie”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Elon”, “given” : “Lisa”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Parker”, “given” : “Ruth”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Archives of Public Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2014”, “5”, “7” }, “page” : “13”, “publisher” : “BioMed Central”, “title” : “Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population?”, “type” : “article-journal”, “volume” : “72” }, “uris” : “http://www.mendeley.com/documents/?uuid=8e919e4c-300d-41ce-a497-2fb1d17d532f” } , “mendeley” : { “formattedCitation” : “(Poorman <i>et al.</i>, 2014)”, “plainTextFormattedCitation” : “(Poorman et al., 2014)”, “previouslyFormattedCitation” : “(Poorman <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Poorman et al., 2014) . It is also important to note that, simply claiming that the intervention is theory based is not helpful while synthesising the evidence. More critical evaluation of the applied theory would be needed for better understanding of the usefulness and effectiveness of the SBCC interventions.

The Health Model (HBM)This is a psychological model that attempts to explain and predict health behaviours by focusing on the beliefs and attitudes of individuals. This model is based on the understanding that an individual will take up a health related behaviour when that person feels that the health condition can be avoided ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/1475-2875-13-1”, “ISSN” : “1475-2875”, “abstract” : “Strong evidence suggests that quality strategic behaviour change communication (BCC) can improve malaria prevention and treatment behaviours. As progress is made towards malaria elimination, BCC becomes an even more important tool. BCC can be used 1) to reach populations who remain at risk as transmission dynamics change (e.g. mobile populations), 2) to facilitate identification of people with asymptomatic infections and their compliance with treatment, 3) to inform communities of the optimal timing of malaria control interventions, and 4) to explain changing diagnostic concerns (e.g. increasing false negatives as parasite density and multiplicity of infections fall) and treatment guidelines. The purpose of this commentary is to highlight the benefits and value for money that BCC brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change. “, “author” : { “dropping-particle” : “”, “family” : “Koenker”, “given” : “Hannah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Keating”, “given” : “Joseph”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Alilio”, “given” : “Martin”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Acosta”, “given” : “Angela”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Lynch”, “given” : “Matthew”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Nafo-Traore”, “given” : “Fatoumata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Malaria Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2014”, “1”, “2” }, “page” : “1”, “publisher” : “BioMed Central”, “title” : “Strategic roles for behaviour change communication in a changing malaria landscape”, “type” : “article-journal”, “volume” : “13” }, “uris” : “http://www.mendeley.com/documents/?uuid=96cc79ff-1a04-4fd0-8665-721a5658c408” } , “mendeley” : { “formattedCitation” : “(Koenker <i>et al.</i>, 2014)”, “plainTextFormattedCitation” : “(Koenker et al., 2014)”, “previouslyFormattedCitation” : “(Koenker <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Koenker et al., 2014). Also, the person has to have a positive expectation that comes with taking up a recommended health action. This positive expectation can be that the disease or health condition can be avoided if the recommended action is taken. Lastly, the individual has to believe that they can successfully adopt the recommended action. This model is commonly used in health interventions and studies show that it has been successful in tackling problems of HIV, Tuberculosis as well as obesity ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Portsmouth”, “given” : “Linda”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Trede”, “given” : “F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Olsen”, “given” : “M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Communicating in the health sciences”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013”, “2”, “25” }, “page” : “249-259”, “publisher” : “Oxford University Press”, “title” : “Communicating with the community about health”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=aef67c23-021b-372e-93f5-ca56a5af2402” } , “mendeley” : { “formattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “plainTextFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)”, “previouslyFormattedCitation” : “(Portsmouth, Trede and Olsen, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Portsmouth, Trede and Olsen, 2013).

Figure STYLEREF 2 s 2.3. SEQ Figure * ARABIC s 2 1: The Health Belief Model (adopted from Glanz et al, 2002)Trans theoretical model (TTM)TTM is one of the most popular communication theories in the field of health promotion. It has been investigated by a lot of health, social as well as behavioural scientists. This model states that the process of behaviour change is made up of 5 stages. The first stage is precontemplation where the individual is not concerned about a certain outcome. The second stage is the contemplation stage ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “The emergence of social media introduced a new dimension to communication. The media is increasingly being used in almost every aspect of human endeavor u2013 from marketing and brand promotion to information sharing and relationship building. In view of the participatory nature of social media and its potential for expansive reach of audience, public health professionals are enthusiastic about employing it for communicating behavior change interventions. While evidence indicates the potential benefits of social media tobehavior change communication, this paper, drawing on current literature, emphasizes the need for a strategic deployment of the media. The review highlights some of the challenges of using social media for behavior change communication purposes. Many of the challenges can, however, be mitigated, and this paper highlightsstrategiesthat could enhancethe value of social media for behavior change communication. The paper stresses the need for a two-way communication using social media, working with the audience in developing appropriate communication strategies, and the need for effective evaluation.”, “author” : { “dropping-particle” : “”, “family” : “Adewuyi”, “given” : “Emmanuel Olorunleke”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Adefemi”, “given” : “Kazeem”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Journal of Communication and Health”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2016” }, “page” : “109-116”, “title” : “Behavior Change Communication Using Social Media: A Review”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=f15e3c93-b7fb-4245-9721-67bf14d52d52” } , “mendeley” : { “formattedCitation” : “(Adewuyi and Adefemi, 2016)”, “plainTextFormattedCitation” : “(Adewuyi and Adefemi, 2016)”, “previouslyFormattedCitation” : “(Adewuyi and Adefemi, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Adewuyi and Adefemi, 2016).
In addition to these five stages, the model postulates that the transition between these stages is influenced change processes as well as the disadvantages and the advantages of the change and self-efficacy. These change processes can be divided into two groups: experiential (emotional and cognitive) as well as behavioural (observation and social/situational). The processes of change may include decision balance, self-efficacy and temptation.
Diffusion of Innovation Theory
An idea or innovation gets momentum and diffuses or spreads through a specific population or social system. Adoption, however, does not occur simultaneously, some people may be more apt to adopt it than other ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “Health education can be defined as any combination of learning experiences designed to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes. 1 Specifically focused on the communication aspect, Information, Education and Communication (IEC) was developed in the early 1970s, when the use of mass media proved to be a useful tool in disseminating health information. IEC can range from didactic one-way communication to entertaining methods. It can utilize a wide range of media channels and materials. Regardless of the approach, IEC is usually implemented by a public health or medical expert who gives recommendations to an audience. Fundamentally, the IEC approach assumes that people will follow health advice when they are provided with the ” right ” information. Introducing the health consumer’s point of view: Social Marketing Although IEC improved many aspects of communication, and evidence showed that it could increase knowledge and improve attitudes, it often did not result in behavior change because topics were largely limited to what health experts considered to be important and were conveyed from their perspective. Therefore, in many cases health outcomes did not change. In the mid-1970s, health communication practitioners began to consider lessons from the commercial marketing sector, where consumer analysis proved to be the most critical aspect of successfully promoting products to target audiences. From this, Social Marketing was created to apply commercial marketing approaches to promoting products, services or behaviors that would improve health. Social marketing uses research to bring the consumer perspective to the forefront, and uses the client’s (consumer’s) point of view to define a social problem and consequently the marketing and media mix that can be used to respond to it. Social marketing also recognizes that communication (i.e., promotion) is only one element of the marketing mix; and that products and behaviors, placement, and pricing could be equally important to achieving objectives.”, “author” : { “dropping-particle” : “”, “family” : “The Manoff Group”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “page” : “1-4”, “title” : “Defining Social and Behavior Change Communicacion (SBCC) and Other Essential Health Communication Terms”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=e3704905-ebcf-4b14-9d43-dcb960d03e99” } , “mendeley” : { “formattedCitation” : “(The Manoff Group, 2012)”, “plainTextFormattedCitation” : “(The Manoff Group, 2012)”, “previouslyFormattedCitation” : “(The Manoff Group, 2012)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(The Manoff Group, 2012). There are five established terms that categorise these adoptions. The key to adoption is that the person must perceive the idea, behaviour, or product as new or innovative. It is through this that diffusion is possible. In public health, Diffusion of Innovation Theory is used to accelerate the adoption of important public health programs that typically aim to change the behavior of a social system. The most successful adoption of a public health program results from understanding the target population and the factors influencing their rate of adoption.

Figure STYLEREF 2 s 2.3. SEQ Figure * ARABIC s 2 2: Diffusion of Innovation Adopter Categories (Adopted from ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/10410236.2013.873363”, “ISSN” : “1532-7027”, “PMID” : “25010519”, “abstract” : “The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behavior. Statistical evaluation supported a model where the indirect effect of exposure on behavior through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.”, “author” : { “dropping-particle” : “”, “family” : “Jones”, “given” : “Christina L”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jensen”, “given” : “Jakob D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Scherr”, “given” : “Courtney L”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Brown”, “given” : “Natasha R”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Christy”, “given” : “Katheryn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Weaver”, “given” : “Jeremy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Health communication”, “id” : “ITEM-1”, “issue” : “6”, “issued” : { “date-parts” : “2015” }, “page” : “566-76”, “publisher” : “NIH Public Access”, “title” : “The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.”, “type” : “article-journal”, “volume” : “30” }, “uris” : “http://www.mendeley.com/documents/?uuid=ebc721f3-278f-3c05-8a0f-32e9ce249cc4” } , “mendeley” : { “formattedCitation” : “(Jones ;i;et al.;/i;, 2015)”, “plainTextFormattedCitation” : “(Jones et al., 2015)”, “previouslyFormattedCitation” : “(Jones ;i;et al.;/i;, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Jones et al., 2015))Social Cognitive Theory (SCT)
The social cognitive theory explains how people acquire and maintain certain behavioural patterns, while also providing the basis for intervention strategies ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0716728508”, “abstract” : “Ideal for advanced undergraduate or graduate courses, or for professional use, the book is based on Bandura’s theory that those with high self-efficacy expectancies – the belief that one can achieve what one sets out to do – are healthier, more effective, and generally more successful than those with low self-efficacy expectancies. He begins with a discussion of theory and method: what self-efficacy is and how it can be developed. Bandura then demonstrates how belief in one’s capabilities affects development and psychosocial functioning during the course of life, underscoring provocative applications of this work to issues in education, health, psychopathology, athletics, business, and international affairs. The nature of human agency — Human agency in triadic reciprocal causation — Determinism and the exercise of self-influence — Related views of personal efficacy — Perceived self-efficacy as a generative capability — Active producers versus passive foretellers of performances — The self-efficacy approach to personal causation — Multidimensionality of self-efficacy belief systems — Self-efficacy causality — Sources of discordance between efficacy judgment and action — Enactive mastery experience — Vicarious experience — Verbal persuasion — Physiological and affective states — Integration of efficacy information — Cognitive processes — Motivational processes — Affective processes — Selection processes — Origins of a sense of personal agency — Familial sources of self-efficacy — Peers and the broadening and validation of self-efficacy — School as an agency for cultivating self-efficacy — Growth of self-efficacy through transitional experiences of adolescence — Self-efficacy concerns of adulthood — Reappraisals of self-efficacy with advancing age. Students’ cognitive self-efficacy — Teachers’ perceived efficacy — Collective school efficacy — Biological effects of perceived self-efficacy — Perceived self-efficacy in health promoting behavior — Prognostic judgments and perceived self-efficacy — Anxiety and phobic dysfunctions — Depression — Eating disorders — Alcohol and drug abuse — Development of athletic skills — Self-regulation of athletic performance — Collective team efficacy — Psychobiological effects of physical exercise — Career development and pursuits — Mastery of occupational roles — Self-efficacy in organizational decision making — Self-efficacy in enactment of occupational roles — Collective organizatu2026”, “author” : { “dropping-particle” : “”, “family” : “Bandura”, “given” : “Albert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “1997” }, “number-of-pages” : “604”, “publisher” : “Worth Publishers”, “title” : “Self-efficacy : the exercise of control”, “type” : “book” }, “uris” : “http://www.mendeley.com/documents/?uuid=d362aee8-d86a-3be1-892a-7d233fd5af37” } , “mendeley” : { “formattedCitation” : “(Bandura, 1997)”, “manualFormatting” : “(Bandura, 1997)”, “plainTextFormattedCitation” : “(Bandura, 1997)”, “previouslyFormattedCitation” : “(Bandura, 1997)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Bandura, 1997). Evaluating behavioural change depends on the factors environment, people and behaviour. SCT provides a framework for designing, implementing and evaluating programs. The three factors environment, people and behaviour are constantly influencing each other. Behaviour is not simply the result of the environment and the person, just as the environment is not simply the result of the person and behaviour ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/10410236.2013.873363”, “ISSN” : “1532-7027”, “PMID” : “25010519”, “abstract” : “The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behavior. Statistical evaluation supported a model where the indirect effect of exposure on behavior through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.”, “author” : { “dropping-particle” : “”, “family” : “Jones”, “given” : “Christina L”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jensen”, “given” : “Jakob D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Scherr”, “given” : “Courtney L”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Brown”, “given” : “Natasha R”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Christy”, “given” : “Katheryn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Weaver”, “given” : “Jeremy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Health communication”, “id” : “ITEM-1”, “issue” : “6”, “issued” : { “date-parts” : “2015” }, “page” : “566-76”, “publisher” : “NIH Public Access”, “title” : “The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.”, “type” : “article-journal”, “volume” : “30” }, “uris” : “http://www.mendeley.com/documents/?uuid=ebc721f3-278f-3c05-8a0f-32e9ce249cc4” } , “mendeley” : { “formattedCitation” : “(Jones <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Jones et al., 2015)”, “previouslyFormattedCitation” : “(Jones <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Jones et al., 2015). The environment provides models for behaviour. Observational learning occurs when a person watches the actions of another person and the reinforcements that the person receives ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0716728508”, “abstract” : “Ideal for advanced undergraduate or graduate courses, or for professional use, the book is based on Bandura’s theory that those with high self-efficacy expectancies – the belief that one can achieve what one sets out to do – are healthier, more effective, and generally more successful than those with low self-efficacy expectancies. He begins with a discussion of theory and method: what self-efficacy is and how it can be developed. Bandura then demonstrates how belief in one’s capabilities affects development and psychosocial functioning during the course of life, underscoring provocative applications of this work to issues in education, health, psychopathology, athletics, business, and international affairs. The nature of human agency — Human agency in triadic reciprocal causation — Determinism and the exercise of self-influence — Related views of personal efficacy — Perceived self-efficacy as a generative capability — Active producers versus passive foretellers of performances — The self-efficacy approach to personal causation — Multidimensionality of self-efficacy belief systems — Self-efficacy causality — Sources of discordance between efficacy judgment and action — Enactive mastery experience — Vicarious experience — Verbal persuasion — Physiological and affective states — Integration of efficacy information — Cognitive processes — Motivational processes — Affective processes — Selection processes — Origins of a sense of personal agency — Familial sources of self-efficacy — Peers and the broadening and validation of self-efficacy — School as an agency for cultivating self-efficacy — Growth of self-efficacy through transitional experiences of adolescence — Self-efficacy concerns of adulthood — Reappraisals of self-efficacy with advancing age. Students’ cognitive self-efficacy — Teachers’ perceived efficacy — Collective school efficacy — Biological effects of perceived self-efficacy — Perceived self-efficacy in health promoting behavior — Prognostic judgments and perceived self-efficacy — Anxiety and phobic dysfunctions — Depression — Eating disorders — Alcohol and drug abuse — Development of athletic skills — Self-regulation of athletic performance — Collective team efficacy — Psychobiological effects of physical exercise — Career development and pursuits — Mastery of occupational roles — Self-efficacy in organizational decision making — Self-efficacy in enactment of occupational roles — Collective organizatu2026”, “author” : { “dropping-particle” : “”, “family” : “Bandura”, “given” : “Albert”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “1997” }, “number-of-pages” : “604”, “publisher” : “Worth Publishers”, “title” : “Self-efficacy : the exercise of control”, “type” : “book” }, “uris” : “http://www.mendeley.com/documents/?uuid=d362aee8-d86a-3be1-892a-7d233fd5af37” } , “mendeley” : { “formattedCitation” : “(Bandura, 1997)”, “plainTextFormattedCitation” : “(Bandura, 1997)”, “previouslyFormattedCitation” : “(Bandura, 1997)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Bandura, 1997). The concept of behaviour can be viewed in many ways. Behavioural capability means that if a person is to perform a behaviour he must know what the behaviour is and have the skills to perform it.

Figure STYLEREF 2 s 2.3. SEQ Figure * ARABIC s 2 3: The Social Cognitive Model ( adopted from ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1111/obr.12225”, “ISBN” : “1467-7881”, “ISSN” : “1467789X”, “PMID” : “25428600”, “abstract” : “This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.”, “author” : { “dropping-particle” : “”, “family” : “Young”, “given” : “M. D.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Plotnikoff”, “given” : “R. C.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Collins”, “given” : “C. E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Callister”, “given” : “R.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Morgan”, “given” : “P. J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Obesity Reviews”, “id” : “ITEM-1”, “issue” : “12”, “issued” : { “date-parts” : “2014” }, “page” : “983-995”, “title” : “Social cognitive theory and physical activity: A systematic review and meta-analysis”, “type” : “article-journal”, “volume” : “15” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb994ca-0250-449b-8bf3-cc45e7f78129” } , “mendeley” : { “formattedCitation” : “(Young <i>et al.</i>, 2014)”, “manualFormatting” : “Young et al., 2014)”, “plainTextFormattedCitation” : “(Young et al., 2014)”, “previouslyFormattedCitation” : “(Young <i>et al.</i>, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Young et al., 2014)
References
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Adewuyi, E. O. and Adefemi, K. (2016) ‘Behavior Change Communication Using Social Media: A Review’, International Journal of Communication and Health, 9, pp. 109–116. Available at: http://communicationandhealth.ro/upload/number9/EMMANUEL-O-ADEWUYI.pdf.

Bandura, A. (1997) Self-efficacy?: the exercise of control. Worth Publishers. Available at: https://books.google.co.zw/books/about/Self_Efficacy.html?id=eJ-PN9g_o-EC;redir_esc=y (Accessed: 13 May 2018).

Bhutta, Z. A. et al. (2013) ‘Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?’, The Lancet, 382(9890), pp. 452–477. doi: https://doi.org/10.1016/S0140-6736(13)60996-4.

Black, R. E. et al. (2013) ‘Maternal and child undernutrition and overweight in low-income and middle-income countries’, The Lancet, 382(9890), pp. 427–451. doi: https://doi.org/10.1016/S0140-6736(13)60937-X.

Free, C. et al. (2013) ‘The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review’, PLoS Medicine. Edited by T. Cornford. Public Library of Science, 10(1), p. e1001362. doi: 10.1371/journal.pmed.1001362.

Haileslassie, K., Mulugeta, A. and Girma, M. (2013) ‘Feeding practices, nutritional status and associated factors of lactating women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia’, Nutrition Journal, 12(1), p. 28. doi: 10.1186/1475-2891-12-28.

Jones, C. L. et al. (2015) ‘The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.’, Health communication. NIH Public Access, 30(6), pp. 566–76. doi: 10.1080/10410236.2013.873363.

Koenker, H. et al. (2014) ‘Strategic roles for behaviour change communication in a changing malaria landscape’, Malaria Journal. BioMed Central, 13, p. 1. doi: 10.1186/1475-2875-13-1.

Korda, H. and Itani, Z. (2013) ‘Harnessing Social Media for Health Promotion and Behavior Change’, Health Promotion Practice. SAGE PublicationsSage CA: Los Angeles, CA, 14(1), pp. 15–23. doi: 10.1177/1524839911405850.

Lamstein, S. et al. (2014) ‘Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia Findings from a Systematic Literature Review RECOMMENDED CITATION Evidence of Effective Approaches to Social and Behavior Change C’. Available at: https://www.spring-nutrition.org/sites/default/files/publications/series/spring_sbcc_lit_review.pdf (Accessed: 13 May 2018).

Leslie, J. et al. (2015) ‘Effects of Behaviour Change Communication Strategies Embedded in Social Marketing Programs on Health Behaviours and Related Health and Welfare Outcomes in Low and Middle Income Countries’. Available at: http://campbellcollaboration.org/lib/project/283/.

Poorman, E. et al. (2014) ‘Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population?’, Archives of Public Health. BioMed Central, 72(1), p. 13. doi: 10.1186/2049-3258-72-13.

Portsmouth, L., Coyle, J. and Trede, F. (2013) ‘Working as a member of a health team’, Communicating in the health sciences. Oxford Press, pp. 271–279. Available at: https://espace.curtin.edu.au/handle/20.500.11937/30495 (Accessed: 13 May 2018).

Portsmouth, L., Trede, F. and Olsen, M. (2013) ‘Communicating with the community about health’, Communicating in the health sciences. Oxford University Press, pp. 249–259. Available at: https://espace.curtin.edu.au/handle/20.500.11937/34321 (Accessed: 13 May 2018).

Sreekumaran, N. et al. (2016) ‘Effectiveness of Behaviour Change Communication Intervention in Delivering Health Messages on Antenatal Care for Improving Maternal and Child Health Indicators in a Limited Literacy Setting: An Evidence Summary of Syste,atic Reviews’, (August), pp. 1–45.

The Manoff Group (2012) ‘Defining Social and Behavior Change Communicacion (SBCC) and Other Essential Health Communication Terms’, pp. 1–4. Available at: http://manoffgroup.com/documents/DefiningSBCC.pdf.

Thompson, C. et al. (2015) Thompson et al 2014.

WHO (2010) ‘Indicators for assessing infant and young child feeding practices.’, Part 3 Country Profiles, pp. 1–47. doi: ISBN 978 92 4 159975 7.

Young, M. D. et al. (2014) ‘Social cognitive theory and physical activity: A systematic review and meta-analysis’, Obesity Reviews, 15(12), pp. 983–995. doi: 10.1111/obr.12225.

Chapter three
MethodologyStudy SettingThe study will be conducted in the Mangwe district of Matebeleland South, Zimbabwe. Mangwe district is one of the four districts in which the program Amalima operates in.
Study Design
The study design to be used is a cohort. Questionnaires were interview administered by trained personnel. The questions asked were focusing on antenatal care (ANC) as well as Infant and Young Child Feeding (IYCF). Different cohorts were interviewed every year. 38 beneficiaries were interviewed per village for four years. Five villages were chosen at random which gives a total number of 95 respondents a year. The cohorts consisted of 19 mothers/caregivers of children with 0 to 5 months of age as well as 19 mothers/caregivers of children with 6 to 23 months of age. This means that a total of 190 respondents were interviewed each year.

Sampling and Sample size determination
Over the years the programme had an average of 2500 pregnant and lactating women who were its beneficiaries. The minimum sample size of this study was calculated using this number. Using 10% margin of error and 95% significance the minimum sample size was found to be 93 (www.surveymonkey.com). However, a total of 190 respondents were interviewed in the district each year, half being mothers/caregivers of children aged 0 to 5 months and the other half being mothers/caregivers of children aged 6 to 23 months.

The method used for sampling was stratified random sampling. Out of 4 districts, only one was chosen at random. In that districts 5 villages were then randomly chosen to participate in the study. Using a list of known beneficiaries who qualified in the study, 38 households were chosen at random, 19 with children aged 0 to 5 months and another 19 with children aged 6 to 23 months.

Inclusion and exclusion criteria
Participants of the study were beneficiaries of the Amalima program. All households with members who are beneficiaries of Amalima nutrition activities were be considered for the study. These households had children under the age of 2 years. Non beneficiary households as well as beneficiary households that did not have children under the age of 2 were not included in the study
Data collection and Tools
A pretested questionnaire was used to collect the data. The questionnaire was interviewer administered. The questionnaire had different sections that were addressing the different objectives of the study. Data was collected over a period of 4 years in successive cohorts. A different cohort was interviewed each year.

Statistics and Data analysis
SPSS was used for data analysis. The analysis was based on determining the associations between SBSS and changes in nutritional behaviours. The indicators that were being measured were on maternal health and nutrition as well as infant and young child feeding (IYCF). Early registration and frequency of ANC visits was the main focus in maternal health whereas in child health the focus was on early initiation of breastfeeding and exclusive breastfeeding for children under 6 months as well as continued breastfeeding, minimum acceptable meal frequency and dietary diversity score for children aged 6 to 23 months. The purpose for the analysis was to examine the changes in nutritional behaviours as a result of the implementation of the intervention.

Chapter 4
Results
Questionnaires were used in collecting data for this study. A total of 8 indicators were measured in the fields of maternal health and Infant and Young Child Feeding. Baseline and endline data was collected and compared for all the 8 indicators. The analysis of this data was to determine if there are significant differences between the baseline and the endline data.
Indicator 1: Care group participation

Fig 3.1: Care group participation of mothers of children under 2 years over 4 years
Care group participation increases every year for both mothers of children aged 0 to 5 months and those with children aged 6 to 23 months. The data shows that the participation of mothers of children with 6 to 23 months of age is higher than that of mothers of children under 6 months. There is an average difference of 27% between these groups. The 6 to 23 months group showed a higher improvement (25%) compared to the 0 to 5 months group (12%).

Indicator 2: Frequency of ANC visits

Fig 3.2: frequency of ANC visits during pregnancy
The frequency of ANC visits showed an increase an increase over the years from 71% to 99%. There was rapid rise of 19 % in the number of pregnant women going for the minimum recommended number of ANC visits between year 2 and year 3.
Indicator 3: Early registration for ANC

Fig 3.3: Early registration for Antenatal Care by Pregnant women
The number of pregnant women who register of antenatal care at 3 months or before rose significantly over the years. There was a total increase of 19% between year 1 and year 4. However, there was a drastic increase in frequency between the years 2 and 3.
Indicator 4: Exclusive Breastfeeding

Fig 3.4: Number of lactating women practicing EBF
The rate of exclusive breastfeeding increased in the district from 81% in the first year to 95% in the final year. A great increased was observed between the first and second years whose difference are 8% as opposed to 2% between year 2 and year 3 as well as 3% between year 3 and year 4.

Indicator 5: Early initiation of breastfeeding

Fig 3.5: Number of lactating women who breastfed their children within 1 hour of delivery
The data shows that there was no change in breastfeeding initiation time in the first 2 years. However, on year 3 there was a rapid increase in the number of women who breastfed their new-born babies within the first hour of birth. In year 3 82% of the women initiated their children with 1 hour of delivery as opposed to 79% from the previous year. Only 1% changed was seen between year 3 and year 4. There was an overall increase of 7%.

Indicator 6: Continued breastfeeding

Fig 3.6: proportion of women who breastfed their children until they were at least 12 months old
According to ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “ISBN 978 92 4 159975 7”, “ISBN” : “978 92 4 159666 4”, “ISSN” : “1098-6596”, “PMID” : “25246403”, “author” : { “dropping-particle” : “”, “family” : “WHO”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Part 3 Country Profiles”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2010” }, “page” : “1-47”, “title” : “Indicators for assessing infant and young child feeding practices.”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=3718d408-1c96-4c46-8c47-c9b78d128403” } , “mendeley” : { “formattedCitation” : “(WHO, 2010)”, “manualFormatting” : “WHO, 2010”, “plainTextFormattedCitation” : “(WHO, 2010)”, “previouslyFormattedCitation” : “(WHO, 2010)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }WHO, 2010, continued breastfeeding refers to the proportion of children who were breastfed up to at least 12 months of age. The data shows that there was a 14% increase in the proportion of children who were breastfed until at least a year of age over the 4 years. In the first 2 years there was no change and there was a 9% increase between years 2 and 3.

Indicator 7: Minimum acceptable diet

Fig 3.7 proportion of children who consumed the minimum meal frequency
The frequency of children who consumed an acceptable number of meals during the previous increased over time as well as the frequency of children with a dietary diversity score of at least .4/7. It was observed that most of the change occurred between years 2 and 3. The indicator minimum acceptable diet is defined as the number of children who consumed the minimum acceptable number of meals as well as had a dietary diversity score of at least 4/7 ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “ISBN 978 92 4 159975 7”, “ISBN” : “978 92 4 159666 4”, “ISSN” : “1098-6596”, “PMID” : “25246403”, “author” : { “dropping-particle” : “”, “family” : “WHO”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Part 3 Country Profiles”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2010” }, “page” : “1-47”, “title” : “Indicators for assessing infant and young child feeding practices.”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=3718d408-1c96-4c46-8c47-c9b78d128403” } , “mendeley” : { “formattedCitation” : “(WHO, 2010)”, “plainTextFormattedCitation” : “(WHO, 2010)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(WHO, 2010). Minimum acceptable diet was constant at 39% for the first 2 years. However, contrary to the expectations that it will go up as the dietary diversity score and minimum meal frequency go up, minimum acceptable diet rates decreased with time. Between year 2 and 3 there was a 7% decrease in the number of children who consumed a minimum acceptable diet. A further decrease of 1% was observed between year 3 and year 4.

Crosstabs showing dependency between the variables and care group participation
Care group participation Variable Total Yes No 1p value
Early Initiation 89 (93.7%) 42 (91.3%) 47 (95.9%) 0.356
EBF 87 (91.6%) 44 (95.7%) 49 (87.8%) 0.166
ANC frequency 90 (94.7%) 45 (97.8%) 45 (91.8%) 0.191
Early ANC 36 (37.9%) 17 (37.0%) 19 (38.8%) 0.855
Continued BF 79 (83.2% 32 (82.6%) 41 (83.7%) 0.890
MAD 31 (32.6%) 27 (37.0%) 4 (18.2%) 0.099
Regression
Variable Year 1 Year 4 2p value
Early Initiation 76% 84% 0.344
EBF 81% 95% 0.772
Caregroup Participation 42% 63% 0.139
ANC Frequency 71% 99% 0.572
Early ANC 23% 42% 0.277
Continued BF 69% 83% 0.512
MAD 39% 31% ;0.001

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