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ImpactMojo 101 Series · Free Forever

Behaviour
Change
Communication

From Awareness to Action — a Foundational Course in SBCC for Development & Public-Health Communicators in South Asia

Theory-GroundedSouth Asia Focus100 SlidesFree Access

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Agenda

What We Cover

What BCC & SBCC Are

Slides 3–10

Why Behaviour Is Hard to Change

Slides 11–19

Individual Behaviour Theories

Slides 20–28

Social & Environmental Theories

Slides 29–36

Behavioural Economics & Nudges

Slides 37–45

Knowing Your Audience

Slides 46–53

Formative Research

Slides 54–62

Designing Messages

Slides 63–71

Channels & the Communication Mix

Slides 72–80

Campaigns & Community Engagement

Slides 81–89

Monitoring, Ethics & Examples

Slides 90–99

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Section One

What BCC & SBCC Are

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Definition

Communication that changes what people do

Public-health and development work runs on behaviour — washing hands, using a toilet, attending antenatal care, immunising a child. Behaviour Change Communication (BCC) is the strategic use of communication to help people adopt and sustain healthier, safer behaviours.

Behaviour Change Communication (BCC)

An evidence-based, planned process that uses communication to promote and sustain individual, community and societal behaviour change — not to inform for its own sake, but to move people from intention to action.

BCC is not advertising and not health education alone. It is communication designed around a specific behaviour, a specific audience and the barriers between them.

Behaviour	What has to be true for it
Handwashing with soap	Soap, water, a cue, a habit
Toilet use	A working toilet, and a norm
Antenatal care	A service, transport, permission
Immunisation	A session held, a trusted worker

Every behaviour in this course sits on a chain of preconditions, most of which are not communication problems — which is the point of the SBCC framing rather than a caveat to it.

Name the whole chain before designing a message. The communication component should address the links that are genuinely about knowledge, motivation or norms.

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BCC → SBCC

Why the field added an 'S'

Early programmes focused on the individual: give a person the right message and they will change. Practitioners learned that behaviour is also shaped by families, norms, services and policy — so the field broadened to Social and Behaviour Change Communication (SBCC).

BCC (older lens)

Focus on the individual decision. Persuade the person; assume the environment will follow.

SBCC (current lens)

Work across individual, community and social-norm levels at once — and address the services and policies that enable or block the behaviour.

BCC assumed	SBCC adds
The individual decides	Families and norms decide too
Information is the gap	Services and access matter
Messages persuade	Environments enable
One audience	Several, including gatekeepers

The added S is not a rebranding. It changed what the programme is responsible for: not only the message but the social and service conditions the message assumes.

If your programme still designs for one individual receiving one message, it is doing BCC and should say so rather than claiming the broader frame.

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The Core Claim

Beyond awareness, towards action

AWARENESS: 'I have heard of ORS'

→

KNOWLEDGE: 'I know it treats dehydration'

→

INTENTION: 'I plan to use it'

→

ACTION: 'I gave it during the last episode'

→

MAINTENANCE: 'I use it every time'

Most campaigns stop at awareness. SBCC's job is the whole chain — and especially the drop-offs between each step.

Step	What usually stops it
Awareness to knowledge	The message was vague
Knowledge to intention	No perceived benefit; norms against
Intention to action	Friction, forgetting, cost
Action to maintenance	No cue; no reinforcement

Most campaigns are designed for the first step and evaluated at the fourth, which explains the pattern of high recall and low practice.

Diagnose which step your audience is stuck at before writing anything. The message for a knowledge gap and the message for a friction problem are different messages.

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The Central Problem

The awareness-action gap

The behaviour funnel: people fall away at every step (illustrative)

Illustrative — shape typical of SBCC programme data

High awareness, low practice is the signature pattern of weak campaigns. The gap — not the awareness number — is where the real work lies.

Where people fall away	The design question it raises
Awareness to knowledge	Was the message specific?
Intention to action	What is the friction?

High awareness with low practice is the signature pattern of a weak campaign, and it is also the pattern a campaign optimised for reach will produce.

The gap is the target, not the awareness. Measuring only recall will show the campaign succeeding while the behaviour does not move.

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What SBCC Is Not

Common misconceptions

Not 'more posters'. Volume of messaging is not the same as change.
Not one-off. Behaviour change needs sustained, repeated contact.
Not blame. 'People are ignorant' ignores real barriers.
Not only mass media. Interpersonal contact often does the heavy lifting.

If a campaign assumes that telling people the facts is enough, it has already mistaken the problem.

Misconception	Why it persists
More posters means more change	Output is countable
A one-off campaign works	It fits a project cycle
People are ignorant	It requires nothing of the programme
Mass media is enough	It is visible to funders

Each misconception survives because it is convenient for reporting rather than because anyone believes it on reflection.

The blame framing is worth resisting explicitly in team discussions. It ends the search for the real barrier before it starts.

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Where SBCC Fits

Communication is one lever, not the only one

SBCC works best alongside the other levers of change. A handwashing message fails without soap and water nearby; an immunisation message fails without a functioning session and a friendly nurse.

SBCC can do

Shift attitudes, norms and intentions
Build skills and self-efficacy
Cue and remind at the right moment

SBCC cannot do alone

Supply soap, toilets, vaccines or clinics
Fix a hostile or distant service
Remove the cost of changing

Message fails without	Which is
Soap and water nearby	Supply
A held immunisation session	Service delivery
A friendly, present nurse	Service quality
A toilet that works	Infrastructure
Permission to travel	Social

SBCC is one lever among several, and a campaign delivered into a setting missing any of these produces awareness and resentment.

Where you find a structural block, your job is to flag it to whoever can fix it rather than to communicate harder around it.

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Roadmap

How this course is built

Understand

Why behaviour resists change
Individual and social theories
Behavioural economics and nudges

Design & Deliver

Audience, research and messages
Channels and campaigns
Monitoring, ethics and Indian examples

Throughout, examples come from India and the wider region — the behaviours and campaigns you will actually meet at work.

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Section Two

Why Behaviour Is Hard to Change

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The Hard Truth

Knowledge alone rarely changes behaviour

The oldest assumption in health communication is that if people knew better, they would do better. Decades of evidence say otherwise: knowledge is necessary but almost never sufficient.

We are not short of people who know smoking is harmful, that handwashing saves lives, that helmets prevent injury. Knowing is the easy part.

— a recurring lesson of SBCC practice

If knowledge changed behaviour, no doctor would smoke. This single insight reshapes how you design every campaign.

Knowledge is	Knowledge is not
Necessary	Sufficient
Cheap to deliver	The usual binding constraint
Easy to measure	What you are trying to change

The knowledge-deficit assumption is the oldest and most persistent in health communication, and it survives because knowledge is the easiest thing to deliver and to count.

Smoking is the canonical counter-example: awareness of harm is near-universal and behaviour change required prices, bans, cues and social norms.

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Two Gaps

The knowledge gap and the intention-action gap

KNOWLEDGE GAP: don't know what or how

→

ATTITUDE: know, but don't value it

→

INTENTION: value it, plan to act

→

INTENTION-ACTION GAP: plan, but don't do

→

BEHAVIOUR: actually do it

Two different gaps need two different responses. Information closes the first; cues, skills and removing friction close the second — the harder, more neglected one.

Gap	What closes it
Knowledge gap	Information, demonstration
Attitude gap	Benefit framing, emotion
Norm gap	Visible social proof
Intention-action gap	Cues, defaults, reduced friction

Naming which gap you are addressing is the single most useful discipline in campaign design, because each gap has a different remedy.

The last row is the one communication is worst at and behavioural design is best at, which is why Section 5 exists.

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Intention-Action Gap

Most people who intend, still don't act

From intention to action, people leak away (illustrative)

Illustrative — pattern documented across behaviours

Good intentions are real but fragile. The design question is not 'how do I create intention?' but 'how do I help intention survive contact with daily life?'

Between intention and action sit	Addressed by
Forgetting	A timely reminder
Friction	Removing a step

Asking someone to name when and where they will act raises follow-through, and costs one question.

The design question is therefore not how to create intention but how to convert the intention that already exists.

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Why Intentions Fail

What stands between wanting and doing

Forgetting: the moment to act passes unnoticed
Friction: the behaviour is even slightly inconvenient
Habit: the old behaviour fires automatically
Present bias: the cost is now, the benefit is later
Competing demands: survival crowds out 'good for you'

Each failure has a design fix — reminders, defaults, making the act easy, linking to existing routines. SBCC is as much about friction as about persuasion.

Why intentions fail	What to do about it
Forgetting	A cue at the moment
Friction	Remove a step
Habit	Attach the new act to an existing routine
Present bias	Make the benefit immediate or visible
Competing demands	Reduce the time cost

None of these is addressed by more information, which is why campaigns that raise intention successfully still see no change in practice.

Attaching a new behaviour to an existing routine is the most reliable of these, and it costs nothing: handwashing after using the toilet rather than handwashing in general.

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Social Barriers

Behaviour is watched, judged and shared

Few behaviours are private. A young wife's antenatal visit, a man's vasectomy, a girl's menstrual hygiene — all are governed by what families, neighbours and elders permit, expect or shame.

Social barriers

Norms about what 'people like us' do
Family gatekeepers — mothers-in-law, husbands
Stigma, gossip and reputation

Why it matters

An individual may be fully convinced and still not act, because acting would defy the people they live among.

Behaviour	Who is watching
Antenatal visit	The mother-in-law; neighbours
Vasectomy	Male peers; the wider family
Menstrual hygiene	Household elders
Toilet use	The whole hamlet

Treating any of these as a private decision misdescribes it. The person performing the behaviour is often not the person deciding it.

This is why the gatekeeper audience in Section 6 is frequently more important than the primary audience.

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Structural Barriers

Sometimes the barrier is not in the head

No amount of messaging overcomes a missing toilet, an absent nurse, a four-hour walk to a clinic, or a wage lost to attend a session. These are structural barriers — outside the individual's control.

Diagnosing a structural barrier as an attitude problem is the most expensive mistake in SBCC. You will run a campaign against a wall that no message can move.

Structural barrier	Communication cannot
No toilet	Build one
Absent nurse	Staff the clinic
Four-hour walk	Shorten the distance
A lost day’s wage	Replace the income

Where the barrier is structural, a campaign transfers responsibility to people who cannot act on it, which is both ineffective and unfair.

Formative research exists partly to find these before the campaign is designed. Discovering them at evaluation is the standard failure.

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Ability vs Motivation

Make it easy before you make it desired

When a behaviour is hard, even strong motivation fails. When a behaviour is easy, even modest motivation succeeds. Practitioners often over-invest in motivation and under-invest in making the behaviour easy.

Reduce friction

Bring the behaviour closer, simpler, cheaper, faster

Then motivate

Add reasons once the act is genuinely doable

If ability is	And motivation is	Then
Low	High	Behaviour still fails
High	Low	Behaviour often succeeds
Low	Low	Fix ability first
High	High	It happens

The second row is the counter-intuitive one and is the strongest practical argument for investing in making the behaviour easy before making it desired.

Programmes systematically over-invest in the motivation column because it is what communication budgets can buy.

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Implication

Design around barriers, not assumptions

Find the real barrier before choosing a message
Separate the gaps — knowledge vs intention vs ability
Address norms, not just individuals
Flag structural blocks to those who can fix them
Make the behaviour easy wherever you can

The rest of this course is, in effect, a toolkit for doing exactly this — barrier by barrier.

Design step	Common shortcut
Find the real barrier	Assume it is knowledge
Separate the gaps	Treat them as one
Address norms	Address individuals
Flag structural blocks	Message around them
Make it easy	Make it desired

The right column is what a campaign designed under deadline looks like, and each shortcut has a predictable failure mode.

A week of formative research is cheaper than a campaign aimed at the wrong barrier, and it is the step most often cut.

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Section Three

Individual Behaviour Theories

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Why Theory

Theories are maps of why people act

A behaviour theory is a tested explanation of what drives a behaviour. It tells you which levers to pull — so you design from evidence, not instinct. This section covers three classic individual-level theories.

Behaviour-change theory

A structured account of the factors that cause a behaviour and how they interact — used to diagnose barriers and select communication strategies.

A theory tells you	It does not tell you
Which lever to pull	Which is weak in your context
What predicts the behaviour	What your audience believes
Where to probe in research	The answer

Theories are diagnostic instruments rather than templates. They tell you what to ask about; formative research tells you what is actually true here.

Programmes that pick a theory and design straight from it skip the diagnosis and end up addressing whichever construct the theory emphasises.

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Health Belief Model

The Health Belief Model (HBM)

One of the earliest health-behaviour theories. It says people act when they believe a threat is real and that acting is worth it. Developed by U.S. public-health researchers in the 1950s.

Construct	The question in the person's head
Perceived susceptibility	Could this happen to me?
Perceived severity	Would it be serious if it did?
Perceived benefits	Will this action actually help?
Perceived barriers	What will it cost me to act?
Cues to action	What prompts me to do it now?
Self-efficacy	Can I actually do it?

HBM construct	The question it asks
Perceived susceptibility	Could this happen to me?
Perceived benefits	Would acting help?
Perceived barriers	What would it cost me?

The barriers construct most often decides the outcome and is addressed least, because it points at cost.

Developed in the 1950s to explain low uptake of free screening; it treats the decision as individual.

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HBM in Practice

Reading a behaviour through the HBM

Take an expectant mother skipping antenatal check-ups. The HBM asks: does she think complications could affect her? Does she see them as serious? Does she believe check-ups help more than they cost?

The model's gift to communicators: perceived barriers usually outweigh perceived benefits. Lowering the felt cost of acting often beats raising fear of the disease.

Ask the mother	Rather than telling her
Do you think complications could affect you?	Complications are dangerous
Would a check-up help?	Check-ups are important
What would it cost you to go?	Please attend
Who decides whether you go?	It is your health

The last row is outside the HBM entirely and is often the operative answer in South Asian settings, which is a limitation of an individual-level model.

Use the model to structure the questions and be ready for the answer to be about permission rather than perception.

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Theory of Planned Behaviour

Theory of Planned Behaviour (Ajzen)

Icek Ajzen's Theory of Planned Behaviour — an extension of the earlier Theory of Reasoned Action — holds that behaviour follows from intention, which is built from three things.

ATTITUDE: do I view the behaviour positively?

→

SUBJECTIVE NORM: do important others approve?

→

PERCEIVED CONTROL: do I feel able to do it?

→

→ INTENTION → BEHAVIOUR

The crucial addition over Reasoned Action is perceived behavioural control — the felt sense of 'I can do this', which also directly affects whether the act happens.

TPB component	Ask	If weak
Attitude	Do I think it is good?	Show the benefit
Subjective norm	Do respected others approve?	Show social proof
Perceived control	Can I actually do it?	Demonstrate; simplify

The value of the model is that it separates three things campaigns habitually merge, and each has a distinct communication remedy.

It also has a known limit, which the next section addresses: intention predicts behaviour only weakly, so all three levers can be strong and the behaviour still not happen.

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TPB in Practice

Three levers, three messages

Attitude

Show the behaviour as good and rewarding

Norms

Show that respected others do & approve of it

Control

Show it is feasible — demonstrate, simplify

TPB tells you which lever is weak for your audience — and therefore which message to lead with. Don't preach attitude when the real block is felt control.

If the weak lever is	The message should
Attitude	Show the benefit, vividly
Norms	Show respected others doing it
Control	Demonstrate; simplify; reassure

TPB’s practical value is exactly this diagnosis: it tells you which of three messages to make rather than telling you to make all three.

Formative research is what identifies the weak lever. Without it, teams default to the attitude message, which is the one they find easiest to write.

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Stages of Change

The Transtheoretical Model (Prochaska & DiClemente)

Prochaska and DiClemente observed that people change in stages, not in one leap. Their Transtheoretical Model maps the journey — and warns against treating everyone as if they are ready to act.

Stage	Wrong message for it
Precontemplation	A detailed how-to
Contemplation	More facts

The model catches the single message aimed at a mixed audience, most of whom are at another stage.

The stages are contested academically; as a design heuristic the model remains useful.

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Match the Stage

Meet people where they are

Stage	Where the person is	Communication job
Precontemplation	Not even considering change	Raise awareness, plant doubt
Contemplation	Weighing pros and cons	Tip the balance; show benefits
Preparation	Intending to act soon	Give a concrete plan and skills
Action	Doing it, recently started	Reinforce, reward, problem-solve
Maintenance	Sustaining the new behaviour	Prevent relapse, build habit

Aiming an 'act now' message at someone in precontemplation wastes both your effort and their patience. Segment by stage.

Stage	Communication job	Channel that suits
Precontemplation	Raise awareness; plant doubt	Mass media
Contemplation	Tip the balance	Mid-media, peers
Preparation	Give the how and the where	Interpersonal
Action	Support and reduce friction	Interpersonal, cues
Maintenance	Reinforce; make it normal	Community, norms

Reading the third column shows why a campaign needs a mix: no single channel serves the whole journey, and mass media serves only its beginning.

It also tells you what to sequence. Interpersonal contact deployed before anyone is contemplating is expensive and premature.

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Using the Theories

No single theory explains everything

HBM is strong on perceived threat and the cost-benefit of acting
TPB adds social approval and felt control over the act
Stages of Change reminds you that readiness varies
Good programmes borrow constructs from several, fit to the behaviour

Treat theories as a diagnostic toolbox, not doctrine. Pick the constructs that explain your behaviour and audience.

Take from	The construct
HBM	Perceived barriers and benefits
TPB	Subjective norms and control
Stages of change	Readiness varies
Social cognitive theory	Self-efficacy and modelling
COM-B	A diagnostic checklist

Good programmes borrow constructs rather than adopting a theory wholesale, and say which construct their design is targeting.

COM-B, later in this course, is the most usable synthesis: it collapses most of these into three components you can diagnose in a morning.

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Section Four

Social & Environmental Theories

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Beyond the Individual

Behaviour lives in a social ecosystem

Individual theories explain the person; social theories explain the world around them. The socio-ecological model reminds us that behaviour sits inside nested layers of influence.

Layer	Example lever
Individual	Knowledge, efficacy
Family and peers	Gatekeeper permission

The socio-ecological model is a checklist rather than a theory: it prevents a design that addresses only the innermost layer.

Most campaigns work on the inner layers; the binding constraint is often in the outer ones.

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Social Cognitive Theory

Social Cognitive Theory (Bandura)

Albert Bandura showed that people learn behaviours by observing others — modelling — and by seeing those others rewarded. Change is a constant interplay between the person, their behaviour and their environment (reciprocal determinism).

Observational learning: we copy credible models
Vicarious reinforcement: we act when models are rewarded
Self-efficacy: belief in one's own ability to do it

This is the theoretical engine behind role-model storytelling and entertainment-education — show a relatable character succeeding, and viewers believe they can too.

Bandura’s mechanism	Design implication
People learn by observing	Show the behaviour being done
Especially similar others	Use relatable models, not celebrities
Rewarded behaviour is copied	Show the reward
Person, behaviour and environment interact	Change more than the person

The second row is the practical one: a model similar to the audience in age, caste, income and setting is far more effective than an aspirational one.

This is the theoretical basis for entertainment-education and for the positive-deviance approach, both of which appear later in the course.

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Self-Efficacy

Self-efficacy: 'I can do this'

Self-efficacy (Bandura)

A person's belief in their own capacity to perform a specific behaviour. It is behaviour-specific — high for one act, low for another — and is a powerful predictor of whether intention becomes action.

Mastery

Small successes build belief — demonstrate, let them practise

Modelling

Seeing 'someone like me' succeed raises efficacy

Self-efficacy is raised by	Not by
Doing it successfully once	Being told it is easy
Seeing someone similar do it	Seeing an expert do it
Encouragement from a trusted person	General exhortation
Breaking it into small steps	Presenting the whole task

Bandura ordered these by strength, and the first — mastery experience — is far more powerful than the others, which is why demonstration beats explanation.

Self-efficacy is behaviour-specific. A woman confident about immunisation may have low efficacy about negotiating a hospital delivery, and they need separate work.

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Diffusion of Innovations

Diffusion of Innovations (Rogers)

Everett Rogers described how new ideas and practices spread through a community over time — not all at once, but in waves, starting with a small group of risk-tolerant adopters.

Adopter categories spread over time (Rogers)

Rogers, Diffusion of Innovations — standard proportions

Group	Rough share	What they need
Early adopters	A small minority	Status; being first
Early majority	About a third	Proof from peers

The proportions are regularities, not laws; the insight is that adoption spreads in sequence.

Measuring coverage against the whole population from month one makes the early phase look like failure.

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Using Diffusion

Find and back the early adopters

Innovators & early adopters are your entry point — reach them first
Opinion leaders bridge to the majority; their endorsement matters most
The early majority waits for proof from people like them
Laggards need the behaviour to become the new normal before they move

Don't try to convert everyone at once. Seed the behaviour with credible early adopters and let it diffuse along social ties.

Adopter group	What moves them
Innovators	Novelty; low risk aversion
Early adopters	Being first; status
Early majority	Proof from people like them
Late majority	Norms; it is now expected
Laggards	Structural support, or nothing

Rogers’s categories are descriptive proportions rather than fixed types, and their practical use is sequencing: reach the early adopters first and let them carry it.

Opinion leaders bridge to the majority, and identifying them locally is worth the formative research time. They are rarely the formally powerful.

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Social Norms

We do what we think others do

Descriptive norm

What I believe most people actually do — 'everyone here defecates in the open'.

Injunctive norm

What I believe most people approve of — 'using a toilet is what respectable families do'.

Powerful and double-edged: telling people 'too many still defecate in the open' can normalise the very behaviour you oppose. Highlight the growing healthy norm instead.

	Descriptive norm	Injunctive norm
States	What people do	What people approve of
Example	"Everyone defecates in the open"	"Respectable families use a toilet"
Risk	Can reinforce the bad behaviour	Can shame

Getting these two confused produces the classic backfire: telling people that most still practise the bad behaviour communicates that it is normal.

Where the descriptive norm is against you, lead with the injunctive one, or with a trend — "more families every month" — rather than a level.

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Norms in Practice

Shifting the norm, not just the person

When a behaviour is governed by norms, persuading individuals one by one is slow and fragile. Changing the shared expectation lets many people change together, with social cover.

Public commitments, community pledges and visible role models work because they change what people believe their neighbours expect — the heart of community-led approaches in the next sections.

Norm-shifting device	How it works
Public commitment	Makes the new intention visible
Community declaration	Changes what is expected of everyone
Visible markers	Signal who has changed
Collective action	Removes the cost of being first

The last row is the mechanism: where a behaviour is norm-governed, the first person to change bears a social cost, and collective change removes it.

This is why CLTS-style community triggering, in Section 10, outperforms individual persuasion for sanitation, and why individual subsidies did not.

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Section Five

Behavioural Economics & Nudges

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A Different Lens

People are predictably irrational

Classical models assume people weigh costs and benefits rationally. Behavioural economics shows we rely on mental shortcuts and are swayed by how choices are framed — in ways that are systematic and predictable.

This is liberating for communicators: if behaviour responds to context and framing, then small design changes — not just big persuasion — can move it.

Classical assumption	What actually happens
People weigh costs and benefits	They use shortcuts
Preferences are stable	Framing changes them
More options are better	Choice overload
Information changes decisions	Context often matters more

The word predictable in the phrase is the useful part: these deviations are systematic, so they can be designed for rather than merely deplored.

This is a complement to the theories in Sections 3 and 4 rather than a replacement. It explains the intention-action gap those models leave open.

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COM-B

The COM-B model (Michie)

Susan Michie's COM-B model sits at the centre of the Behaviour Change Wheel. It says any behaviour requires three things at once — remove any one and the behaviour fails.

Component	Missing means
Capability	They cannot, even if willing
Opportunity	The context blocks it
Motivation	They will not, even if able

All three are required simultaneously, which is what makes COM-B a diagnostic: identify the missing one and the intervention type follows.

It sits at the centre of Michie’s Behaviour Change Wheel, which maps each deficit onto specific intervention functions and policy levers.

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COM-B in Use

Diagnose which component is missing

Component	Ask	If missing, then…
Capability	Do they know how & feel able?	Teach, demonstrate, build skills
Opportunity	Does the environment allow it?	Fix access, cues, norms, time
Motivation	Do they want to, in the moment?	Reasons, emotion, habit, incentives

COM-B's discipline: diagnose before you prescribe. A motivation campaign cannot fix an opportunity problem.

Component	Diagnostic question	If missing
Capability	Do they know how, and feel able?	Teach; demonstrate
Opportunity	Does the context allow it?	Fix access, cues, norms
Motivation	Do they want to, in the moment?	Framing, incentives, habit

COM-B’s strength is that all three must hold simultaneously, which makes it a fast diagnostic: find the missing one and you know where the effort belongs.

In development settings opportunity is the missing component more often than the other two, and it is the one communication addresses least.

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Cognitive Biases

Shortcuts that shape decisions

Present bias: we over-value now over later
Loss aversion: losing ₹100 hurts more than gaining ₹100 pleases
Status quo bias: we stick with the default
Social proof: we follow what others seem to do
Availability: vivid recent events feel more likely

Biases are not flaws to lecture away — they are levers. Design with the grain of how minds actually work.

Bias	Design response
Present bias	Bring the benefit forward; make the cost later
Loss aversion	Frame as avoiding a loss
Status quo bias	Change the default
Social proof	Show what similar others do
Availability	Make the relevant case vivid

These are levers rather than curiosities, and each has a documented effect size in field experiments that is small but reliable.

Small and reliable is worth having at scale. A default change that moves uptake a few points costs nothing and applies to everyone.

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Nudges

Defaults, framing and commitment

Defaults

Make the healthy option the automatic one — opt-out, not opt-in

Framing

Same fact, better wording — '90% protected' vs '10% at risk'

Commitment

Small public pledges make people follow through

Nudge

A change in how choices are presented that steers behaviour predictably without forbidding options or changing economic incentives — popularised by Thaler & Sunstein.

Nudge type	Example in a programme
Default	Opt-out enrolment in a scheme
Framing	"90% protected" rather than "10% at risk"
Commitment	A signed pledge at a village meeting
Reminder	An SMS the day before the session
Simplification	A one-page form instead of four

Simplification is the least glamorous and most effective of these. Reducing a four-step process to two changes uptake more than most messaging.

The nudge definition matters: it alters behaviour without forbidding options or significantly changing incentives. A large payment is not a nudge.

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Choice Architecture

The design of the decision shapes the choice

Every decision happens inside an environment — the order of options, the default, the friction, the salient cue. The choice architecture is never neutral; the only question is whether you designed it deliberately.

Putting the immunisation register at the anganwadi door, or making ORS the first item on a shelf, is choice architecture — quiet design that beats loud persuasion.

Choice architecture element	Who currently designed it
The default	Whoever wrote the form
The order of options	Nobody, usually
The friction at each step	The bureaucracy
What is salient	Accident

The environment is never neutral. The only question is whether the person who shaped it was thinking about the behaviour they were producing.

Walk through your own service as a user would, step by step, and count the frictions. It is the cheapest diagnostic in this course.

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EAST

A practical checklist: make it EAST

Principle	Meaning
Easy	Reduce friction; use simple defaults and clear steps
Attractive	Draw attention; make it personal and appealing
Social	Show that others are doing it; harness norms
Timely	Prompt at the moment people are most receptive

EAST, from the UK Behavioural Insights Team, is a quick field test for any behavioural intervention you design.

EAST	The test
Easy	Have you removed a step?
Attractive	Does it draw attention?
Social	Does it show what others do?
Timely	Does it arrive at the decision moment?

The framework comes from the UK Behavioural Insights Team and is deliberately crude: four checks that a non-specialist can apply to any intervention.

Timeliness is the most under-used. A reminder the week before is worth much less than one the morning of, and both cost the same.

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Limits

Nudges are not a substitute for systems

Nudges work at the margin — they don't supply missing services
Overused, they can feel manipulative or paternalistic
They must be transparent and in the person's genuine interest
Structural barriers still need structural fixes

A nudge towards handwashing is no answer to a village with no water. Use behavioural design and fix the system.

Nudges can	Nudges cannot
Close an intention-action gap	Supply a missing service
Raise uptake at the margin	Overcome a structural barrier
Be cheap and scalable	Substitute for infrastructure
Work quietly	Be used without transparency

The critique that nudging distracts from structural reform is a fair one where it substitutes for it, and not where it complements it.

The transparency test is practical: would you be comfortable telling the audience exactly what you did and why? If not, it is manipulation.

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Section Six

Knowing Your Audience

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First Principle

There is no such thing as 'the public'

'The community' is not one audience. A new mother, her mother-in-law, the ASHA, the village head and the absent migrant husband each see a behaviour differently. Speaking to everyone usually means reaching no one.

If you are talking to everybody, you are talking to nobody.

— a maxim of audience-centred communication

In one village, the audience includes	Who sees the behaviour as
A new mother	Her own decision, partly
Her mother-in-law	A family decision
The ASHA	Her target and her workload
The village head	A programme in his area
The absent husband	Something he pays for

Speaking to everyone usually means reaching nobody, because a message that fits all five is too general to move any of them.

Choose the audience whose change is the binding constraint. In much of South Asia that is the gatekeeper rather than the person performing the behaviour.

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Segmentation

Audience segmentation

Dividing a broad population into smaller groups that share characteristics, barriers or motivations — so messages, channels and messengers can be tailored to each group rather than averaged across all.

Demographic: age, sex, education, location
Behavioural: current practice and stage of change
Psychographic: values, fears, aspirations
By barrier: grouped by what stops them

Segment by	When it matters
Barrier faced	Always — the most useful cut
Stage of readiness	When the audience is mixed
Role (doer, gatekeeper)	When permission is the constraint
Media access	When designing the mix

Segmenting by barrier rather than by demographics is the move that changes the design, because two women of the same age and income may face entirely different obstacles.

Demographic segmentation is easy and usually uninformative. It tells you who they are and not why they are not acting.

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Three Audiences

Primary, secondary and influencing audiences

PRIMARY: the person whose behaviour must change

→

SECONDARY: those close who shape that behaviour

→

INFLUENCING / TERTIARY: leaders & policy who set the climate

Example — primary: the pregnant woman; secondary: husband and mother-in-law; influencing: the panchayat, the ASHA, local health policy. A good campaign speaks to all three layers.

Audience	Example, antenatal care
Primary	The pregnant woman
Secondary	Mother-in-law, husband
Influencing	ASHA, panchayat, block officer

Budgets and creative effort usually go entirely to the primary audience, and the decision frequently sits with the secondary one.

Design at least one message and one channel for the secondary audience explicitly. It is the highest-return reallocation available in most campaigns.

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Gatekeepers

The people who hold the gate

In much of South Asia, a woman's health behaviour is often decided for her. The mother-in-law, husband or elder is frequently the real gatekeeper — and may be a more important audience than the person who performs the behaviour.

Mapping gatekeepers is not optional. Miss them and your message reaches a person who lacks the power to act on it.

Gatekeeper	What would move them
Mother-in-law	Status; a healthy grandchild; her own experience honoured
Husband	Cost; time away from work; his role named
Elder or village head	Community standing; being consulted
Frontline worker	Workload; recognition; a workable process

Gatekeepers are usually addressed, when at all, as obstacles. Treating them as an audience with their own motivations changes what you can offer them.

The mother-in-law is the clearest case: her authority is real, her experience is a source of pride, and a campaign that bypasses her invites her to block it.

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Barriers & Motivators

What stops them? What would move them?

Barriers

Cost, distance, time, lost wages
Fear, stigma, past bad experience
Disapproval of family or neighbours
Low self-efficacy — 'I can't'

Motivators

Protecting one's child
Respect, status, belonging
Convenience and saving money
Approval of trusted others

Motivators are rarely 'health' in the abstract. People act for love, pride, money and belonging — design for those.

Barrier	Motivator that can outweigh it
Lost wages	A visible benefit to the child
Fear of the facility	A trusted, familiar worker
Family disapproval	Approval shown by respected others
Low self-efficacy	Seeing a peer succeed

Barriers and motivators should be found in research rather than assumed, and the pairing matters: a motivator that does not address the actual barrier does not move anyone.

Lost wages is the one motivators rarely outweigh. Where that is the barrier, the answer is compensation or timing, not communication.

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Personas

Make the audience a real person

A persona turns a segment into a named, concrete character — with a life, a routine, a barrier and a motivator — so the whole team designs for a real human, not an abstraction.

Persona example

Sunita, 23, first-time mother, rural Bihar

Lives in a joint family; her mother-in-law decides clinic visits. Owns a shared phone, watches TV serials at night. Barrier: can't leave the house alone. Motivator: desperate for a healthy baby. Reachable via: the ASHA and her husband.

A persona needs	Not
A name and an age	A demographic bracket
A routine, hour by hour	A list of attributes
One specific barrier	A summary of all barriers
One motivator, in her words	A programme objective

The persona is a design device: it makes the whole team argue about one concrete person rather than about an average that nobody resembles.

Build it from real interviews, not from imagination. A persona invented in a workshop encodes the team’s assumptions and gives them a face.

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Insight

From data to a single human insight

The goal of all this audience work is one sharp insight: the true, often surprising reason a person does or doesn't act — expressed in their own emotional logic, not the programme's.

Weak insight: 'mothers lack awareness of immunisation'. Strong insight: 'mothers fear the fever after the shot more than the disease it prevents'. The second tells you exactly what to address.

Weak insight	Strong insight
Mothers lack awareness	She has heard it and does not believe it applies to her
People do not value hygiene	A clean house is a matter of pride; hands are not part of it
Uptake is low	Going means admitting to her mother-in-law that she is unsure

The right column is specific, surprising and expressed in the person’s own logic, which is what makes it usable by a creative team.

The test of an insight is whether it suggests a message you would not have written otherwise. If not, it is a restatement of the problem.

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Section Seven

Formative Research

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Research First

Understand the behaviour before you design

Formative research is the listening you do before creating any message — to learn what people actually do, why, and what would move them. Skipping it is the commonest cause of campaign failure.

Formative research

Early, exploratory research that shapes an intervention — understanding the audience, the behaviour, its barriers and motivators — before messages, materials or channels are decided.

Formative research answers	Before you
What do people actually do?	Assume the gap
Why?	Choose a theory
What would move them?	Write a message
Who do they trust?	Pick a messenger
What words do they use?	Draft any copy

Skipping this is the commonest cause of campaign failure, and it is skipped because it sits between funding and visible output.

It need not be large. Twenty in-depth interviews and two days of observation will answer most of these for one behaviour in one district.

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What to Find Out

The questions formative research answers

Who currently does the behaviour — and who doesn't?
What are the real barriers and motivators for each group?
Who and what do people trust as sources?
What language, images and channels resonate locally?
Which small, feasible action can we realistically ask for?

Notice: not one of these can be answered from a desk. Formative research is fieldwork, mostly qualitative.

Question	Why it matters
Who already does it?	They are your models
What is the real barrier?	It decides the message
Who do they trust?	It decides the messenger
What words do they use?	It decides the copy
What channels do they use?	It decides the mix

Each answer decides a different design element, which is why formative research is not background reading but the source of the brief.

The fourth is under-valued. Copy written in programme vocabulary reads as official and is discounted accordingly.

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Methods

How formative research is done

Method	Good for	Note
In-depth interviews	Personal, sensitive behaviours	Rich, but small numbers
Focus group discussions	Norms, shared language, reactions	Beware dominant voices
Observation	What people actually do vs say	Reveals the say-do gap
Trials of improved practices	Testing a behaviour in real homes	Households try, then report
Quick surveys	Rough prevalence & segments	Sizing, not deep 'why'

Watch the say-do gap: what people report in a group and what they do at home often differ. Observe where you can.

Method	Best for	Watch
In-depth interviews	Sensitive, personal behaviour	Small numbers
Focus groups	Norms and shared language	Dominant voices
Observation	What people do, not say	Observer effect
Free listing / ranking	Local categories and priorities	Needs skilled facilitation
Quick survey	How common, and where	Cannot explain why

Observation is the method that most often contradicts the others. What people report about handwashing and what they do differ substantially and predictably.

Focus groups are poor for prevalence and excellent for language: they tell you the words the audience uses, which is what the copy should use.

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Barrier Analysis

Barrier analysis

Barrier analysis is a structured method to find which factors most separate people who practise a behaviour from those who don't — so you target the barriers that actually matter.

Pick a specific behaviour

→

Interview practisers and non-practisers

→

Compare their beliefs, norms, efficacy

→

Find the determinants that differ most

→

Design messages against those determinants

Barrier analysis step	Output
Pick one specific behaviour	A definable act
Interview doers and non-doers	Two comparable groups
Compare their beliefs	Which differ significantly
Rank the differences	The barriers that matter
Design against the top ones	A targeted message

The method’s discipline is that it identifies which of many plausible barriers actually separates the two groups, rather than listing all of them.

It requires a genuinely specific behaviour. "Good hygiene" cannot be analysed; "washing hands with soap after cleaning a child" can.

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Doer / Non-Doer

The 'doer / non-doer' approach

At the heart of barrier analysis is a simple comparison: interview people who already do the behaviour (doers) and people who don't (non-doers), and look for the differences.

Doers

What do they believe, who supports them, what made it easy? These are your assets to amplify.

Non-doers

What stops them — belief, norm, access, efficacy? The biggest gap is your priority barrier.

The genius is comparison. The factor on which doers and non-doers differ most is where your communication should aim first.

Ask both groups about	Because the difference is the lever
Perceived benefit	Doers may see one non-doers do not
Perceived barrier	Non-doers may face a specific cost
Social approval	Who supports each group
Self-efficacy	Whether they believe they can
Cues	What prompted the doers

The doer/non-doer comparison is the closest thing formative research has to a control group, and it is cheap.

The doers are also your models and your messengers. People who have already changed, in the same setting, are the most credible source available.

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Self-Efficacy & Norms

Probe the levers, not just the facts

Good formative research doesn't just ask 'do you know X?'. It probes the theory constructs: perceived risk, perceived benefit, felt control, social approval — because those, not facts, predict behaviour.

Tie your questions back to a theory (HBM, TPB, COM-B). Then your findings translate directly into which lever to pull.

Weak question	Better question
Do you know ORS treats dehydration?	What did you give last time, and why?
Is immunisation important?	Who decides whether the child goes?
Do you wash your hands?	Show me where you wash them

Knowledge questions produce the answer the respondent thinks is expected, which is why reported knowledge is high everywhere and predicts little.

Ask about the last actual instance rather than about general practice. Recall of a specific episode is far more accurate than a self-description.

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Sizing the Behaviour

Then count: how common is it, and where?

Qualitative work tells you why; a quick quantitative scan tells you how big and where. Pairing the two lets you prioritise the segments and places where the gap — and the opportunity — is largest.

Use existing data first — NFHS, HMIS, district reports — before commissioning your own survey. Much of the sizing is already done and free.

Qualitative tells you	Quantitative tells you
Why	How many
The mechanism	Where it is worst
The language	Which segment to prioritise
The barrier	How big the gap is

Pairing them lets you target: the qualitative work identifies the barrier and the quick scan tells you which blocks and segments to start in.

Do the qualitative work first. A survey designed before you know the local categories will ask the wrong questions in the wrong words.

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Pretesting

Formative research never really stops

The same listening discipline continues into pretesting (covered in the next section) and into monitoring. Research is not a phase you finish — it is a habit of checking your assumptions against reality throughout.

Budget for it. Programmes that 'have no time for research' spend far more, later, fixing campaigns that didn't land.

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Section Eight

Designing Messages

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One Job

The single overriding communication objective

A strong piece of communication tries to achieve one clear thing with one audience. The Single Overriding Communication Objective (SOCO) forces that discipline before you write a word.

SOCO

Single Overriding Communication Objective — the one specific change in knowledge, attitude or action you want one audience to take away from one message. If you have three SOCOs, you have three messages.

A SOCO names	Example
One audience	First-time mothers, 18-25
One behaviour	Attend the first antenatal visit
One change	By the end of the first trimester
One reason	Because it protects the baby

Writing the SOCO before any creative work forces the team to agree what the communication is for, and disagreements surface at that point rather than at review.

If the SOCO takes more than one sentence, the campaign is trying to do more than one thing and will do neither.

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Cram & Confuse

Too many messages means no message

The strongest temptation in development communication is to say everything at once — nutrition, hygiene, immunisation, family planning — on a single poster. The audience remembers none of it.

Discipline: one behaviour, one audience, one ask, per piece. A campaign can have many materials, but each carries a single, clear job.

One poster carrying	Audience remembers
One behaviour	That behaviour
Three behaviours	Perhaps one
Five behaviours	None
A logo and five behaviours	The logo

The pressure to combine comes from budget efficiency and from every department wanting a place on the material, and it destroys the material’s effect.

The answer is not a smaller font. It is a separate piece for each behaviour, sequenced, or a decision about which behaviour matters most.

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Emotion & Reason

Emotional and rational appeals

Rational appeal

Facts, benefits, evidence — 'ORS replaces fluids lost in diarrhoea'. Necessary, but rarely moving on its own.

Emotional appeal

Feeling, identity, story — a mother's relief as her child recovers. Emotion is what makes a message stick and act.

The best messages braid both: a reason to believe and a feeling to act on. Emotion opens the door; facts justify the choice.

Rational appeal supplies	Emotional appeal supplies
The reason it works	The reason to care
Credibility	Memorability
What to do	Why it matters to me

Neither works alone in practice. A purely emotional appeal leaves people moved and unsure what to do; a purely rational one is understood and forgotten.

The usual ratio in effective work is emotion to open and reason to close, with the specific action stated plainly at the end.

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Fear vs Positive

Fear appeals: handle with great care

Fear can grab attention, but used carelessly it backfires: people deny the threat, feel helpless, or tune out. Fear works only when paired with a clear, doable action that resolves it.

Fear alone fails

'Smoking kills' with no path forward — high threat, low efficacy → denial and avoidance.

Positive framing wins

Show the rewarding, aspirational behaviour — the proud, healthy family — and an easy first step.

Fear works when	Fear fails when
Paired with a doable action	The action is unclear
The threat feels personal	It feels remote
Self-efficacy is high	People feel helpless
Used sparingly	It is the whole campaign

The evidence on fear appeals is that they can work and are easy to get wrong, and the failure mode is denial and avoidance rather than no effect.

The rule to carry: never present a threat without an immediately available action that resolves it. Fear without efficacy produces avoidance.

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Make It Stick

Qualities of a memorable message

Simple: one core idea, plainly said
Concrete: a specific action, not a vague value
Credible: from a trusted source or relatable model
Emotional: makes the audience feel something
Story-shaped: a person, a problem, a change

Ask for a small, specific, feasible action — 'wash hands with soap before feeding your baby' — not 'maintain hygiene'.

Quality	Test
Simple	Can it be repeated after one hearing?
Concrete	Does it name a specific action?
Credible	Would this audience believe this source?
Emotional	Does it make anyone feel something?
Story-shaped	Is there a person and a change?

These are the Heath brothers’ criteria and they hold up well against field experience in this sector.

Concreteness is the one development communication fails most: "improve hygiene" is a value, "wash with soap after the toilet" is an action.

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Messenger

Who says it matters as much as what is said

The same message lands differently from a distant official, a film star, a respected elder, or a neighbour who has done it. Source credibility is part of the message.

For everyday behaviours, a relatable peer — 'someone like me' — often out-persuades a celebrity. Match the messenger to the audience and the behaviour.

Messenger	Best for
A relatable neighbour who has done it	Everyday behaviours
A frontline worker	Advice, and answering doubts
A respected elder	Norm change and permission
A celebrity	Attention and reach, not persuasion
An official	Legitimacy; rarely persuasion

The first row is under-used and the fourth is over-used, because celebrity endorsement is easy to procure and easy to report.

For a behaviour requiring permission rather than persuasion, the elder is the necessary messenger and no amount of reach substitutes.

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Pretesting

Pretest before you print

Pretesting is showing draft materials to a small sample of the real audience and checking comprehension, attractiveness, acceptability and whether they would act — before mass production.

Do they understand the core message correctly?
Is anything confusing, dull or offensive?
Do they see it as for 'people like me'?
Does it prompt the intended action?

Skipping pretesting is gambling a whole budget on an untested guess. One afternoon of pretesting saves crores in wasted print runs.

Pretest for	A failing result
Comprehension	They read a different meaning
Attractiveness	They do not look
Acceptability	It offends or embarrasses
Persuasion	They understand and would not act
Self-reference	"That is not about people like me"

Pretesting with eight to twelve members of the real audience will catch most serious problems and costs a day.

The commonest finding is comprehension failure on an image or a metaphor that seemed obvious to the team, which is the curse of knowledge in visual form.

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Calls to Action

End with a clear, doable ask

Every message should make the next step obvious. A vague hope (‘be healthier’) leaves people unsure what to do; a precise, easy ask (‘take your baby for the 9-month measles shot’) gets done.

Pair the ask with where, when and how — the place, the day, the simple step. Closing the intention-action gap starts with an unmissable call to action.

Vague ask	Doable ask
Be healthier	Take your baby for the 9-month measles shot
Practise good hygiene	Wash with soap before feeding your child
Seek care early	Go to the sub-centre on Tuesday morning
Use a toilet	Use the toilet at the end of your lane

A call to action needs the what, the where and the when. Missing any one of them leaves the audience to supply it, and most will not.

Adding the where and when is free and is the single most common omission in otherwise well-made material.

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Section Nine

Channels & the Communication Mix

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No Magic Channel

Different channels do different jobs

Mass media reaches millions but persuades shallowly; interpersonal contact reaches few but changes deeply. The art is the communication mix — combining channels so each does what it is best at.

Reach vs depth of influence by channel (illustrative)

Illustrative — general SBCC pattern

Channel	Reach	Depth
Mass media	Millions	Shallow
Mid-media	Hundreds per event	Moderate

The trade-off is structural rather than a matter of quality, which is why every serious campaign is a mix and why a single-channel budget is a choice about which half to lose.

Cost per person moves the opposite way. The channel that persuades is the one you can least afford to use at scale, which is the planning problem.

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Channel Map

The four broad channel families

Family	Examples	Strength
Mass media	TV, radio, print, outdoor	Wide reach, awareness, norms
Mid-media / folk	Street theatre, melas, wall art	Local, engaging, trusted
Interpersonal	FLWs, counselling, peer groups	Deep, tailored, persuasive
Digital / mobile	SMS, IVR, WhatsApp, social	Targeted, two-way, cheap

Reach builds awareness; interpersonal contact converts it to action. A campaign that uses only one family usually under-performs.

Family	Does well	Does badly
Mass media	Reach; setting norms	Persuasion; tailoring
Mid-media / folk	Local credibility; attention	Scale; consistency
Interpersonal	Persuasion; doubts	Reach; cost
Digital	Timeliness; two-way	Reaching those without phones

The mix exists because no family does both reach and depth, and a campaign that funds only one is choosing which half of the job to leave undone.

The last row’s weakness is gendered in South Asia: phone ownership and mobile-internet use are markedly lower among women.

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Mass Media

Mass media: reach and the power to set norms

Radio and television still reach vast South Asian audiences, including the less literate. Mass media is unbeatable for awareness and for signalling that a behaviour is becoming the new normal.

But broadcast is one-way and shallow. It can tell millions that toilets matter; it cannot answer the one fear keeping a particular family from building one.

Mass media is unbeatable for	And weak at
Reaching the less literate	Answering a doubt
Signalling a new normal	Tailoring to a segment
Sustaining recall	Demonstrating a skill
Legitimising a behaviour	Closing the intention-action gap

Radio remains substantial in rural South Asia and is regularly underestimated in media plans built from urban assumptions.

Use mass media for the norm and the awareness, and budget separately for the interpersonal contact that converts it. Neither substitutes for the other.

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Mid-Media & Folk

Mid-media and folk forms

Between mass and interpersonal sits mid-media: street plays (nukkad natak), puppet shows, folk songs, video vans, wall paintings and melas — rooted in local culture and able to gather a crowd.

Folk forms carry credibility and emotion that a glossy ad cannot. In low-literacy, high-trust settings they often out-perform broadcast for changing minds.

Mid-media form	Its particular strength
Nukkad natak	Gathers a crowd; handles taboo through humour
Puppet shows	Reaches children and mixed audiences
Folk song	Memorable; travels without you
Video van	Brings audiovisual where there is no screen
Wall painting	Persistent; a standing cue

Folk forms carry credibility that imported formats do not, and they can address sensitive topics obliquely in ways direct messaging cannot.

The trade-off is consistency: a live performance varies by troupe and by night, so message fidelity needs monitoring rather than assumption.

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Interpersonal

Interpersonal communication: the persuasion engine

Interpersonal communication (IPC) — a frontline worker counselling a mother, a peer group, a home visit — allows questions, tailoring, demonstration and trust. It is where intention most often turns into action.

Two-way

People can ask, object, be reassured

Tailored

Address this person's specific barrier

Trusted

A known, credible human face

IPC allows	Which mass media cannot
Questions and doubts	Two-way exchange
Tailoring to this person	Segment of one
Demonstration	Watching someone try
Trust built over visits	Relationship

Interpersonal contact is where intention most often becomes action, and it is the most expensive channel per person, which is the central trade-off in the mix.

It is also the channel most dependent on the worker’s time. Adding an IPC component adds to someone’s day, and that person is usually already full.

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Community Mobilisation

Community mobilisation

Beyond one-to-one, community mobilisation organises groups — women's collectives, self-help groups, village health and sanitation committees — to act together and hold the new behaviour as a shared commitment.

Collective action changes the norm and gives individuals social cover to change. It is the bridge from personal message to community movement — the theme of the next section.

Collective form	What it adds
Women’s collectives	Peer support and a shared norm
Self-help groups	An existing, trusted platform
Village health and sanitation committees	A link to the service
Public declarations	Visible commitment

Community mobilisation converts a private intention into a collective commitment, which is what makes the change hold after the campaign ends.

Where an SHG network already exists, it is usually the cheapest available platform and the one with the most existing trust.

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Digital & Mobile

Digital and mobile channels

Mobile penetration has opened SMS reminders, interactive voice response (IVR), WhatsApp groups and social media — cheap, targeted, two-way, and able to prompt at the right moment to close the intention-action gap.

But mind the divide: phone access skews male, richer, younger and urban. A digital-only campaign can quietly exclude the very people most in need.

Digital channel	Best use	Limit
SMS reminder	Timely prompt	Literacy; number ownership
IVR	Reaching non-readers	Completion rates
WhatsApp group	Peer reinforcement	Who is in the group
Social media	Younger, urban segments	Not the whole audience

The reminder is the highest-value digital application because it addresses the intention-action gap directly, at the moment of decision.

Check whose phone it is. A message to a household number may reach the husband, and a message about the woman’s health may not be welcome there.

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Designing the Mix

Choose channels to fit audience and objective

Match the channel to the audience — what do they actually use and trust?
Match the channel to the job — awareness vs deep persuasion
Layer channels so they reinforce one consistent message
Sequence them — broadcast to seed, IPC to convert
Budget realistically — IPC is powerful but costly to scale

Match the channel to	By asking
The audience	What do they actually use and trust?
The job	Awareness, or persuasion?
The stage	Where in the journey are they?
The moment	When is the decision made?

Layering matters as much as choosing: the same message from a radio spot, a wall painting and an ASHA reinforces, while three different messages compete.

Sequence deliberately. Mass media first to make the behaviour thinkable, interpersonal contact after, and reminders at the decision point.

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Section Ten

Campaigns & Community Engagement

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The Cycle

The SBCC campaign cycle

ANALYSE: audience & behaviour

→

DESIGN: strategy, SOCO, channels

→

DEVELOP & PRETEST: materials

→

IMPLEMENT: roll out the mix

→

MONITOR & EVALUATE: learn & adapt

It is a loop, not a line. Findings from monitoring feed back into analysis and design — campaigns improve by iterating, not by launching once.

Cycle stage	What feeds back
Analyse	Monitoring data from the last round
Design	Pretest findings
Develop and pretest	Audience comprehension
Implement	Field reports on reception
Monitor and evaluate	Into the next analysis

The loop is the point. A campaign designed once and run to completion has no mechanism for discovering that the message is being misread.

Build a mid-course review into the plan with an explicit licence to change the creative. Without it, monitoring produces a report and no change.

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Strategy First

A campaign is a strategy, not a slogan

Behind every good campaign is a written communication strategy: the behaviour, the audiences, the barriers, the SOCO, the messages, the channels, the messengers and the indicators — agreed before any creative work.

The logo and tagline come last. Programmes that start with a slogan and reverse-engineer a strategy almost always miss the real barrier.

A strategy states	Before
The behaviour	Anyone writes copy
The audiences and barriers	Media is bought
The SOCO	The creative brief
The channels and messengers	The budget is split
The indicators	Anything is produced

A slogan without a strategy behind it is the standard failure mode, and it is visible in the output: clever, memorable, and about nothing specific.

The strategy is also what lets you say no to the fifth message someone wants added. Without it, every addition is arguable.

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Community-Led

Community-led change beats top-down telling

When a community diagnoses its own problem and decides to act, the change holds. Outside messengers can catalyse, but ownership — not instruction — sustains behaviour.

People support what they help create.

— a principle of participatory development

Told to	Decided for themselves
Compliance while watched	Change that holds
Resentment at being lectured	Ownership
The programme owns it	The community owns it

Outside messengers can catalyse a decision and cannot make it. That distinction is what separates triggering from instruction.

It also predicts what happens at exit: an externally-owned behaviour ends with the programme, and a locally-owned one does not.

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CLTS

Community-Led Total Sanitation (Kamal Kar)

Community-Led Total Sanitation (CLTS), pioneered by Kamal Kar in Bangladesh, abandons subsidies and lecturing. Instead, facilitators help a whole community confront the reality of open defecation and decide, collectively, to end it.

Triggering: a facilitated 'walk of shame' and self-realisation
Collective decision: the whole village commits, not individuals
Local solutions: people build toilets their own way
Goal: an open-defecation-free (ODF) community

CLTS works because it changes the norm and harnesses collective pride and shame — behaviour theory in action at community scale.

CLTS abandons	In favour of
Individual subsidy	Collective decision
Lecturing about germs	Community self-appraisal
Household targeting	Whole-community status
Outside expertise	Local facilitation

Kamal Kar developed it in Bangladesh and its mechanism is norm change rather than persuasion: the community collectively decides, so nobody bears the cost of being first.

Its most serious critique is the stigma risk: triggering can shame the poorest households, who often lack the means rather than the will to build.

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Entertainment-Education

Entertainment-education

Entertainment-education weaves behaviour-change messages into genuinely entertaining stories — TV serials, radio dramas, films — so audiences learn from characters they love, not lectures they tolerate.

It draws directly on Bandura: viewers model the choices of relatable, rewarded characters. South Asia's serial dramas have long carried messages on dowry, girls' education and family planning this way.

Entertainment-education works because	Not because
Audiences identify with characters	The message is repeated
Characters model the behaviour	The information is new
Consequences are seen	It is entertaining alone
It is voluntarily watched	It is broadcast widely

Bandura’s social cognitive theory is the direct theoretical basis, and the format’s effectiveness depends on the story being genuinely good enough to watch for its own sake.

A drama written primarily to carry messages is usually a poor drama, and a poor drama models nothing because nobody watches it.

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FLW-Led IPC

Frontline workers and ASHA-led communication

India's vast frontline — ASHAs, ANMs and anganwadi workers — are the backbone of interpersonal SBCC. They carry messages the last mile, into homes, in the local idiom, from a familiar face.

~1 million+

ASHAs across India, embedded in their own villages

National Health Mission

Home-based

Counselling at the doorstep, repeatedly, over time

Their power depends on support: training, job aids, manageable workload and respect. Overloaded, untrained FLWs cannot persuade.

ASHA-led IPC gives you	And costs
The last mile, into homes	Her time, already committed
A familiar face and local idiom	Training and supervision
Two-way conversation	Consistency across a million workers
Repeat contact	Incentive alignment

The frontline is the backbone of interpersonal SBCC in India and is also the most over-subscribed resource in the health system.

Any new communication task routed through ASHAs is an addition to a day that is already full and largely incentive-based. Say what it displaces.

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Group Engagement

Groups multiply individual change

Participatory learning and action groups — such as women's self-help groups and participatory women's groups — let members discuss problems, plan together and support each other through change.

Participatory women's group approaches have shown real promise for maternal and newborn health in South Asia — peer support turning knowledge into sustained practice.

Group work adds	Beyond individual counselling
Peer support through the change	Which sustains it
A shared norm in the room	Which lowers the cost of being first
Collective problem-solving	Which surfaces local barriers
Accountability	Which maintains the behaviour

Participatory women’s group approaches have among the strongest evidence bases in this field, particularly for maternal and newborn outcomes in South Asia.

The mechanism is not information transfer. It is collective analysis and mutual support, which is why a lecture to a group is not the same intervention.

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Sustaining It

From campaign to lasting change

Repeat and reinforce — one burst rarely sticks
Build local ownership so change outlives the project
Make the new behaviour the visible norm
Remove the friction so the easy choice is the healthy one
Celebrate progress publicly to lock in the gain

To sustain change	Because
Repeat and reinforce	One burst does not stick
Build local ownership	The project will end
Make the behaviour visible	Norms need evidence
Remove the friction	Motivation decays; ease does not
Celebrate progress	It signals the new normal

The fourth row is the most durable. A behaviour that has become easy persists after the campaign; one held up by motivation decays with it.

Plan the maintenance phase and budget it. Most SBCC funding covers the campaign and stops exactly when reinforcement matters most.

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Section Eleven

Monitoring, Ethics & Examples

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Measure What Matters

From exposure to behaviour

It is easy to count outputs — posters printed, spots aired — and mistake them for results. SBCC monitoring must follow the chain all the way to behaviour.

OUTPUTS: materials produced, sessions held

→

REACH / EXPOSURE: who saw or heard it

→

OUTCOMES: changed knowledge, attitude, norm

→

BEHAVIOUR: what people now actually do

→

IMPACT: health & wellbeing change

Level	What it proves
Outputs	You spent the money
Reach	People could have seen it
Exposure	They did see it
Knowledge and attitude	It landed
Behaviour	It worked

Programmes routinely report the first two and claim the last. The chain is what makes the claim checkable and what shows where it broke.

Where behaviour did not move but exposure and knowledge did, you have located the failure precisely — and that is a useful result rather than a bad one.

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Indicators

Indicators along the chain

Level	Example indicator
Exposure	% who recall the campaign message
Knowledge	% who correctly state when to use ORS
Attitude / norm	% who believe neighbours approve of toilets
Intention	% who intend to immunise their child
Behaviour	% of children fully immunised

Recall is not behaviour. A campaign everyone remembers but no one acts on has failed at the only step that counts.

Level	Indicator	Source
Exposure	% recalling the message	Survey
Knowledge	% stating when to use ORS	Survey
Norm	% believing neighbours approve	Survey
Intention	% intending to immunise	Survey
Behaviour	% who actually did	Survey or records

The norm indicator is the one most often omitted and the most diagnostic in norm-governed behaviours, and it is a single survey question.

Where possible verify behaviour against records rather than self-report. Self-reported handwashing is famously higher than observed handwashing.

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Indian Example

Handwashing with soap

Handwashing campaigns shifted from telling people that germs exist to building a habit tied to specific moments — after the toilet, before feeding a child — using cues, emotion (disgust, nurture) and repetition rather than facts alone.

Reported handwashing at key times, before vs after a campaign (illustrative)

Illustrative — not actual programme figures

Old approach	What worked instead
Explain germs	Tie the act to specific moments
General hygiene messages	After the toilet; before feeding

The shift from knowledge to habit is the clearest illustration in this course of everything in Sections 2 and 5 applied to one behaviour.

Cue and moment are what make it a habit. Handwashing at a named moment can become automatic; handwashing in general cannot.

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Indian Example

Immunisation — Mission Indradhanush

India's Mission Indradhanush paired service delivery with intensive communication — ASHA mobilisation, local influencers, addressing rumours and fears — to reach children who had been missed or partially immunised.

The lesson: communication and service must move together. Demand-generation without a reliable session, or sessions without demand, both fall short.

Mission Indradhanush paired	Which addressed
Service delivery drives	Opportunity
ASHA mobilisation	Interpersonal persuasion
Local influencers	Norms and permission
Rumour response	Specific, live barriers

The rumour-response element is the one worth noting: immunisation hesitancy is frequently driven by a specific circulating claim, and generic messaging does not address it.

Communication without the service drive would have raised demand into an absent session, which is the failure the pairing exists to avoid.

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Indian Example

Swachh Bharat — sanitation at scale

The Swachh Bharat Mission combined infrastructure with one of the largest behaviour-change efforts ever attempted — mass media, celebrity endorsement, CLTS-style community triggering and frontline mobilisation to make toilet use the norm.

It also showed the limits of any campaign: building a toilet is not the same as using it. Sustained behaviour, not construction counts, is the real measure.

Swachh Bharat combined	Contested on
Infrastructure at scale	Quality and usability of construction
Mass media and celebrity	Reach versus depth
CLTS-style triggering	Coercion and shaming reports
ODF declarations	Verification and sustained use

It is among the largest behaviour-change efforts ever attempted, and both its achievements and its criticisms are on a corresponding scale.

The lasting lesson for practitioners is the gap between construction and use: a toilet built is an output, and a toilet used is the behaviour.

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Indian Example

ORS — a quiet behaviour-change success

Promoting oral rehydration solution (ORS) for childhood diarrhoea is among the great public-health communication stories — shifting a simple, low-cost home practice across decades through repeated, consistent messaging and frontline counselling.

ORS shows SBCC at its best: a single, feasible behaviour, a clear benefit (a child who recovers), and patient, sustained promotion — not a one-off campaign.

Why ORS promotion worked	Feature
One simple behaviour	Specific and doable
Low cost, home-based	Little friction
Consistent message over decades	Repetition
Multiple channels, sustained	Mix and persistence

The ORS story is a genuine public-health communication success and its features are unglamorous: one behaviour, repeated consistently, for a very long time.

It is worth citing against the pressure for novelty. Changing the campaign every two years is a common way to lose the accumulated recall.

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Ethics

Persuasion that respects people

Avoid stigma: never shame the poor, the sick or the marginalised
Be truthful: no exaggerated fear or false promises
Respect autonomy: inform and enable, don't coerce
Do no harm: check that messages don't endanger anyone
Be inclusive: reach those usually left out

The line between a nudge and manipulation is honesty and the person's own interest. Stay on the right side of it — deliberately.

Ethical rule	Failing practice
No stigma	Shaming those who cannot comply
Truthfulness	Exaggerated fear; false promises
Respect autonomy	Coercion dressed as motivation
Do no harm	Messages that endanger a woman at home
Be transparent	Concealed persuasion techniques

The fourth row is specific and serious: a message urging a woman to act against her household’s wishes can produce consequences she bears alone.

Check every message against the question of what happens to the audience member after they act on it, in their own household.

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Avoiding Harm

When campaigns backfire

Stigma trap

Shaming open defecation can humiliate the poorest, who often lack means — not will — to build a toilet.

Norm trap

Saying 'most people still don't do X' tells the audience the bad behaviour is normal — reinforcing it.

Ethical SBCC is also effective SBCC. Respect, dignity and truth are not constraints on impact — they enable it.

Trap	What went wrong
Stigma trap	Shaming those who lack means, not will
Norm trap	"Most people still don’t" normalises it
Fear trap	Threat without a doable action
Blame trap	Making the individual responsible for a structural gap

All four are avoidable at the drafting stage by a single question: who could this message hurt, and can they do what it asks?

The norm trap is the easiest to commit accidentally, because reporting a low prevalence figure feels like reporting a fact rather than sending a message.

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Read	For
Rogers, Diffusion of Innovations	How practices spread
Cialdini, Influence	Norms and social proof
Thaler and Sunstein; EAST	Nudges, practically
Michie, Behaviour Change Wheel	COM-B as a diagnostic
Johns Hopkins CCP materials	SBCC practice guidance