As a public relations practitioner involved in various communication projects, I often wonder if well-designed communication programs can genuinely produce the desired impacts. For example, can a program encouraging people to reduce plastic consumption genuinely succeed in reducing plastic waste in a region? Can a campaign promoting daily yogurt consumption improve the digestive health of many families in Indonesia and reduce lifestyle-related diseases? Are efforts to encourage Indonesian mothers to schedule regular check-ups and immunizations for their babies carried out consistently according to their respective schedules in their areas? These questions apply to communication programs in various fields, including corporate communication, product marketing communication, and communication for public affairs.

We see trends changing in various communication approaches, from communication focused on educating or introducing target audiences to a product or issue to more persuasive and personal communication to encourage target audiences to move towards the desired behavior. This growing trend also means that communication moves from the level of awareness to deeper communication, involving self-reflection processes to change behavior ultimately.

This approach is called (Social) Behavioral Change Communication (S)BCC. It seeks to touch more profound levels of human thoughts and emotions and identify factors that motivate them to engage in certain behaviors in their daily lives. These factors include social and cultural norms, economic conditions, and demographic and geographic situations. All factors cause an individual, society, or country to have unique and varied behaviors, which can undoubtedly be changed into positive behaviors.

Understanding Communication and Behavior

Previously, communication and behavioral studies operated separately. Communication studies are generally limited to when the target audience has received the message with minimum analysis of the implementation’s success rate. Meanwhile, behavioral studies analyze gaps surrounding knowledge, attitude, and practice. In reality, communication and behavior have a close relationship that mutually influences each other and potentially brings significant changes to the target audience.
By tracing its roots, we can see that behavior change theory emerged from several theoretical frameworks, including the Social Cognitive Theory (Bandura, 1986), the Theory of Planned Behavior (Ajzen, 1991), and the Transtheoretical Model (Prochaska, 1998). These theories seek to understand the factors and processes that influence human behavior. Some also argue that (S)BCC is a transformation of the Theory of Change that emerged in the 1990s at the Aspen Institute Roundtable on Community Change as a way to model and evaluate various complex community initiatives.

Regardless of its theoretical roots, the complexity of human behavior requires a combination of various thoughts, both in communication and behavior, to effectively achieve its goals. The focus of (S)BCC is on behavior, so creating and delivering messages can genuinely influence the people targeted by these messages. For example, when you know someone very well, you will know exactly what arguments to use and when to use them, making the communication very effective. Considering this basis, (S)BCC can also be applied on a larger communication scale – at the community, organization/institution, and even national and global levels. So, imagine the massive impact of change that (S)BCC can produce if successfully applied to target audiences on a large scale.

(S)BCC in the Health Sector: Success Stories and Challenges

Recognizing the solid relationship between communication and behavior, the health sector has widely adopted (S) BCC because it is believed to transform various human behaviors to promote desired health behaviors in daily life. The (S)BCC approach is considered effective in designing persuasive and targeted messages for various target groups in society regarding specific health behaviors.

Several countries have successfully implemented (S)BCC to address their health issues. One success story comes from Peru, which has successfully reduced the stunting rate from around 28% in 2008 to 13% in 2016. The high commitment of the government, as well as good cooperation with NGOs and the international community, has helped reduce chronic malnutrition in the country. Peru prioritized stunting as a national priority by involving all parties, including children, families, and communities. In addition to financial support reaching USD 250 million (2002) for nutrition and food programs, the Peruvian government provided support through intelligent policies that ensured people visited health centers regularly to check their children’s health conditions. These efforts were complemented by (S)BCC approaches from various stakeholders, increasing public awareness and understanding of stunting and encouraging them to seek healthcare assistance to prevent their children from experiencing stunting.

Peru’s success in addressing stunting issues has spurred many countries facing similar situations, including Cameroon, Ecuador, Guatemala, Indonesia, Madagascar, and Tanzania, to implement (S)BCC in their stunting reduction programs.

Although (S)BCC appears ideal and has yielded success stories, it faces many complex challenges. These challenges lie in the quality during the strategy design process and how relevant parties understand and implement (S) BCC. Here are some key challenges of (S)BCC based on experiences in the health sector:

Firstly, there is a tendency to focus on communication materials rather than the behavior to be changed. Many (S)BCC programs spend time and resources producing various communication materials (e.g., brochures, posters, leaflets, TV ads, etc.). Although these communication materials are expected to attract the attention of target groups, they may not necessarily convince them to change their behavior. This ineffectiveness indicates the need for other efforts beyond producing communication materials to achieve behavior change.

Secondly, messages often focus on providing information about health benefits only and rarely touch on emotional, physical, and social factors. Studies from the London School of Hygiene and Tropical Medicine in Indonesia, India, and Zambia have shown the potential of using emotional drivers such as disgust and nurturing attitudes to change handwashing behavior in communities rather than just repeatedly emphasizing the health benefits of a particular behavior.

Thirdly, targeting too many behaviors and too many target groups in a short period. Studies suggest that focusing on two behaviors and identifying the causal factors more effectively triggers behavior changes. For example, handwashing with soap, eating healthy foods, saving water, and providing exclusive breastfeeding for the first 1,000 days of life would be easier if a few prioritized behaviors were selected and agreed upon to be applied to communities within a certain period.

Fourthly, local actors have limited capacity. Although messages have been meticulously crafted, they may only be effectively conveyed if the deliverers fully understand them. Local actors must have a strong understanding and innovation in delivering messages to target groups for better behavioral outcomes. It requires dedicated efforts to build the capacity of key individuals to truly understand and promote specific behaviors expected to apply in society.

Lastly, gender stereotypes and roles in (S)BCC. There is a tendency to focus on women as the target group in various behavior change programs. However, there are other influential parties in making healthy behavioral decisions. For instance, the role of husbands in providing nutritious food to their pregnant wives has been shown to determine the quality of their children in the future significantly. Often, women serve as the ‘gateway’ to behavior change, but attention should also be given to local cultures to leverage more effective entry points for driving behavior change.

Public Relations Practitioners, a Profession with Direct Impact

Considering the success stories and challenges of (S)BCC, although more than a decade has passed since this approach emerged, as a public relations practitioner, I see an excellent opportunity for communicators to become key players in designing, implementing, and evaluating behavior change communication programs.

It is time for the public relations profession to be strategically positioned to directly impact society, rather than just being seen as ‘icing on the cake’ or the ‘last-resort savior’ of various campaigns or communication programs. Communicators can delve deeper into their target audiences by studying their perspectives, ways of thinking, knowledge, attitudes, and what makes them receptive to a message. Moreover, the astuteness of communicators is tested to identify the most effective communication channels for delivering messages. Another vital aspect is the communicators’ endurance in maintaining program consistency by applying various innovations throughout the program journey and their ability to collaborate with experts in different professions to deepen the issues/sectors being intervened.

The success stories of (S)BCC in various health sector narratives should rightly empower public relations practitioners to apply this approach across multiple communication strategies in other sectors, which have equally high aspirations for changing human behavior.

Quoting the book “Good is the New Cool: Market Like You Give A Damn” by Afdhel Aziz and Bobby Jones, it is time for public relations practitioners who are heavily involved in communication strategy formulation to start thinking ‘transformational’ rather than just ‘transactional.’ There is also an excellent expectation for public relations practitioners to contribute significantly to orchestrating changes in societal behaviors, including influencing policymakers to make more integrated and timely policies, encouraging corporations to commit more deeply to humanitarian issues, or engaging various creative individuals to convey positive messages for better behavioral changes through their product promotions.
With this awareness and capability, the public relations profession will be able to survive and ‘level up’ in this century and beyond.

Author: Asti Putri, Communication Practitioner and Founder of ID COMM
[1] Communication for Governance & Accountability Program, The World Bank, Theories of Behavior Change
[2] https://www.actknowledge.org/services/theory-of-change/history/
[3]https://medium.com/world-of-opportunity/striving-to-invest-in-people-perus-success-in-overcoming-its-stunting-crisis-56b842d5eaca