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Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 185-187

COVID-19 pandemic and role of behavior change communication

Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India

Date of Submission18-Jan-2021
Date of Decision14-Mar-2021
Date of Acceptance27-Mar-2021
Date of Web Publication05-Jul-2021

Correspondence Address:
Dr. Pradnya Dilip Chandanshive
315, 3rd Floor, Department of Community Medicine and Family Medicine, AIIMS, Academic Block, Sijua, Patrapada, Bhubaneswar - 751 019, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_5_21

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Since the onset of the COVID-19 pandemic, various public health interventions have been employed due to the lack of an effective vaccine or treatment against the disease. Despite various global and national initiatives, there is still a lack of compliance among the general public. Hence, there is a need for behavior change communication (BCC) for individuals as well as communities to effectively combat the disease spread. This article attempts to address the issues in implementing public health measures and the role of BCC in controlling the pandemic situation.

Keywords: COVID-19, public health intervention, social and behavior change

How to cite this article:
Taywade M, Chandanshive PD, Pradhan SK. COVID-19 pandemic and role of behavior change communication. Curr Med Issues 2021;19:185-7

How to cite this URL:
Taywade M, Chandanshive PD, Pradhan SK. COVID-19 pandemic and role of behavior change communication. Curr Med Issues [serial online] 2021 [cited 2022 May 18];19:185-7. Available from: https://www.cmijournal.org/text.asp?2021/19/3/185/320658

  Introduction Top

The COVID-19 pandemic struck the world at the beginning of the year 2020 that resulted in the enormous and varied impact across the multiple aspects of human life. It is a disease known to be similar to the severe acute respiratory syndrome and influenza pandemics but still unfamiliar in its origin, pathology, and implications. The new pandemic exposed populations across countries to psychological distress, fatigue, burnout, fear, and stigma, which due to the lack of a specific vaccine needs a rapid and extensive behavior change communication (BCC) strategy to establish desirable protective behaviors.[1]

The Ottawa Charter for Health Promotion launched the idea of health promotion in response to the growing need for a global public health movement.[2] Health promotion, defined as “the process of enabling people to increase control over and improve their health,” comprises three key elements: good governance for health, health literacy, and healthy cities.[3] Furthermore, risk communication can go hand-in-hand with BCC as it enables people at risk to make informed decisions for self-protection and protection of loved ones.[4]

  Behavior Change Communication Top

BCC is defined as “An interactive process with communities (as integrated with an overall program) to develop tailored messages and approaches using a variety of communication channels to develop positive behaviors; promote and sustain individual, community and societal behavior change; and maintain appropriate behaviors.”[5] The stages in the BCC process are: (A) Unaware, or the stage of “pre-contemplation”-where the person is unaware of the existing problem; (B) Aware, or stage of contemplation where a person is aware of the problem and the desired behavior change; (C) Concerned, the stage where the person feels the given information applies to them, and hence, feels motivated to evaluate their behavior; (D) Knowledgeable, the stage following the concerned stage where the person seeks to gather more information in other ways; (E) Motivated to change, the stage at which the person is seriously considering the new information and measures for improving their health; F. Practice of trial behavior change or the stage of “action,” followed by practicing sustained behavior change or the stage of “maintenance.” The stage of maintenance or trial behavior change is when the person decides and tries out the new behavior. If the outcome of this trial seems favorable, then the behavior change is accepted and followed further.[6] These stages are similar to the Transtheoretical model of behavior change, which states that individuals move through the six stages of change of health-related behaviors, i.e., pre-contemplation, contemplation, preparation, action, maintenance, and termination.[7]

For BCC, the messages need to be: (a) Research centered, (B) client centered, (C) benefit learning, (D) service inter-related, (E) professionally developed and interrelated to behavior change, keeping in mind the strategies for conducting BCC activities.[8] There are various methods of BCC-(A) posters, pamphlets, brochures; (B) mass media, videos; (C) stories, short movies, street plays; (D) social and professional discussions; and (E) peer groups, which can be utilized according to the purpose and need of the program.[9]

While BCC focusses on an individual as the locus, there was a need to focus on communities or population as a whole. This led to the concept of Social and BCC (SBCC) where the focus is on “community” as a unit of change to influence both individual and societal changes. It is a more comprehensive approach that involves the process of transforming the distribution of power within social and political institutions. SBCC itself has evolved from the earlier linear “expert-learner” or “sender-receiver” models to an analysis of behaviors and their determinants to affect the changes in knowledge, attitudes, and practices of populations. The SBCC framework uses strategies such as advocacy and community mobilization along with BCC to strengthen the social context, systems, and processes supporting health using research-based consultative process to promote and facilitate behavior change.[9],[10] The social contexts, systems, and processes supporting health include the demography, regional or geographical characteristics, cultural practices, health-care systems, health-related schemes, and programs.

The problem in implementing BCC lies in the lack of understanding people's behavior. Hand washing, wearing a face mask, and social or physical distancing were never the norm for the general public. These behaviors have been introduced due to the COVID-19 pandemic, which was not a very welcome change for the masses. Health educators, promoters, policy-makers possess the core competencies to change health-related human behavior. To enable people to control their health and its determinants is key in health promotion.

  Behavior Change Communication during COVID-19 Top

BCC strategies are based on various Behavior Change Models such as: (a) The Health Belief Model, (B) The Theory of Planned Behavior, (C) Diffusion of Innovation Theory, (D) Social Cognitive Theory, and (E) The Social Norms theory besides the aforementioned Transtheoretical model. The Health Belief Model, which was developed to understand the failure of people to adopt disease prevention strategies, suggests that a person's belief in their vulnerability to a disease or illness along with their belief in the benefit from an intervention determines the likelihood of their adopting certain health behavior. The Health Belief model, while one hand, can be used to plan BCC strategies based on its constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy; on the other hand, its various limitations need to be rectified by the use of other models of behavior change.[11] Although multiple models or theories might be used for an SBCC intervention, some influencing factors might still be missed, for example, the Theory of Planned Behaviour and Health Belief Model do not address the natural human behaviors such as impulsivity, habit, self-control, associative learning, and emotional processing.[12] Hence, before carrying out any behavior change intervention, diligent research on human behavior, needs of the audience and nature of the problem, resource availability, etc., is needed.

An article addressed this problem and found that selection and social influence mechanisms coexist by affecting each citizen's health-related behaviors and community-led risk discourses in the face of the urgent health crisis. The behavior of citizens that makes them capable of voluntarily adopting more health preventive measures signals the severity of current health emergency to rest of the community members. This sense of severity helps in creating social norms for preventive public health measures.[13]

With regard to the application of behavioral theories and models in case of disaster and emergency preparedness, most of the existing evidence is available from developed countries that might not be generalizable to the Asian countries. The Health Belief Model, Theory of Planned Behavior, and Social Cognitive theories were most commonly applied to influenza (H1N1 and H5N1), floods, and earthquake disasters, with most studies conducted in the USA. Few identified studies from Asia, which comprises a greater number of annual disasters and victims than that of other continents.[14]

In India, the Central Government resorted to clever tactics like roping in popular actors like Amitabh Bachchan and integrating BCC messages as caller tunes to promote appropriate preventive behaviors regarding COVID-19 among the public in addition to the conventional television and radio campaigns.[15] For an infectious disease like COVID-19, it is important for the public follow appropriate behaviors to maintain hygiene at a higher level than usual. It is also necessary to maintain restrictions on social gatherings, travelling, and social contact to prevent and control the infection. Most of the interventions involved require active efforts of the individuals and communities to make these modifications in their usual habits and activities. In addition to official guidelines and legislative policies to control the spread of COVID-19, there is a need to educate and convince the population to bring about a change in their behavior.

  Evidence-based Behavior Change Communication Top

While there are studies hand-hygiene and handwashing in certain settings, most of them are not generalizable to community settings.[16],[17],[18] Furthermore, there were no studies available on the effectiveness of BCC for protective measures against COVID-19, although some literature on the application of BCC was found. Behavior change models such as COM-B, i.e., capability, opportunity, motivation-behavior model can be utilized to bring about behavior change specific to high-risk behaviors. For every behavior change, an individual needs the capability, necessary opportunity, and motivation to take appropriate action for behavior change.[19]

  The Way Forward Top

The strength of the Indian public health system lies in its accessibility, reach most of the Indian population and community involvement in the form of grass root level health workers. Using the “One Health” approach, which is a way to design and implement programs, policies, legislation, and research with multi-sectoral coordination, is an essential approach to ensure better outcomes of these behavior change campaigns.[20] Community health-care workers (HCWs) such as ASHA, Anganwadi workers, Health worker Male and Female, are already involved in the regular field activities. Surveys for COVID-19, such as the influenza-like illness survey and Rapid Response Team visits to those under home-isolation. These routine COVID-19-related activities can be used as the opportunity to carry out SBCC programs designed according to the particular community needs. However, this calls for a meticulous training of HCWs and Training of Trainers to enable these HCWs to impart SBCC for the greater benefit.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42.  Back to cited text no. 1
Fuchs A. Ottawa Charter | SpringerLink. Encyclopedia of Public Health; 2008. Available from: https://link.springer.com/referenceworkentry/10.1007%2F978-1-4020-5614-7_2475. [Last accessed on 2020 Nov 04].  Back to cited text no. 2
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Risk Communications. World Health Organization. Available from: https://www.who.int/emergencies/risk-communications. [Last accessed on 2020 Nov 04].  Back to cited text no. 4
Family Health International. Behavior Change Communication (BCC) for HIV/AIDS. USA: USAID; 2002 September. Available from: https://www.hivpolicy.org/Library/HPP000533.pdf. [Last accessed on 2020 Nov 04].  Back to cited text no. 5
Slowing Down the COVID-19 Outbreak: Changing Behaviour by Understanding It – The BMJ. Available form: https://blogs.bmj.com/bmj/2020/03/11/slowing-down-the-covid-19-outbreak-changing-behaviour-by-understanding-it/. [Last accessed on 2020 Nov 04].  Back to cited text no. 6
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Heal Promot 1997;12:38-48.  Back to cited text no. 7
Behavior Change Communication (BCC): Importance and Strategies – Public Health Notes. Available form: https://www.publichealthnotes.com/1142-2/. [Last accessed on 2020 Nov 04].  Back to cited text no. 8
Social and Behavior Change Communication – Johns Hopkins Center for Communication Programs. Available from: https://ccp.jhu.edu/social-behavior-change-communication/. [Last accessed on 2020 Nov 04].  Back to cited text no. 9
Training for Information, Education, and Communication (IEC) Officers Ministry of Health and Family Welfare Government of India; 2013. Available from: https://www.FHI360.org. [Last accessed on 2020 Nov 04].  Back to cited text no. 10
Norman P, Conner M. Health behavior. In: The Curated Reference Collection in Neuroscience and Biobehavioral Psychology. United Kingdom. Elsevier Science Ltd.; 2016. p. 1-37.  Back to cited text no. 11
Theory of Addiction-Robert West, Jamie Brown-Google Books. Available form: https: //books.google.co.in/books?hl=en&lr=&id=sWtwAAAAQBAJ&oi =fnd&pg=PTS&ots=Lv6AZ3jhLR&sig=7FNy1jxsMuv088JWq-WsYhsPVKA&redir_esc=y#v=one page&q&f=false. [Last accessed on 2020 Nov 04].  Back to cited text no. 12
Lim S, Nakazato H. The emergence of risk communication networks and the development of citizen health-related behaviors during the COVID-19 pandemic: Social selection and contagion processes. Int J Environ Res Public Health 2020;17:1-2.  Back to cited text no. 13
Ejeta LT, Ardalan A, Paton D. Application of behavioral theories to disaster and emergency health preparedness: A systematic review. PLoS Curr 2015;7. Available from: https://pmc/articles/PMC4494855/?report=abstract. [Last accessed on 2021 Mar 12].  Back to cited text no. 14
Reddy BV, Gupta A. Importance of effective communication during COVID-19 infodemic. Fam Med Prim Care 2020;9:3793.  Back to cited text no. 15
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