Health Communication and Behavior Change

URC uses health communication and behavior change practices to enable individuals, families, communities, and societies to increase control over and improve their health. Our overall goal is to stimulate and sustain individual and social changes and contribute to better health outcomes.

URC's approach recognizes that human behavior is complex and results from a combination of context-specific influences, including environmental factors, social norms, health policies, the quality of health services, and individual knowledge. For this reason, we apply a systematic, continuous process shaped by evidence and feedback to develop and monitor multi-level, multi-media health communication and behavior change interventions that are part of our projects in over 45 countries.

URC's projects combine many of the communication channels, tactics, and strategies described below to foster better health outcomes:

• Advocacy aims to secure leaders’ commitment to policies and programs that support health and promote changes in social conditions that contribute to disease and vulnerability.
• Social and community mobilization engages civil society and community organizations to promote social norms that support collective health objectives and challenge harmful practices.
• Mass media, such as radio, TV, billboards, and newspapers, complement other media to raise awareness and increase knowledge of health concerns, stimulate audiences to seek services, and promote social norms that favor healthy practices.
• Interpersonal communication from trusted sources, such as health providers, faith-based organizations, and community outreach workers, are influential in changing attitudes, improving knowledge, and building skills to carry out health behaviors.
• Channels based on tradition and popular culture, specific to the geographic context, entertain and engage while transferring important messages and encouraging dialogue and interaction. These include popular theater, puppetry, music, dance, pageants, festivals, and more.
• Job aids and other materials improve health workers’ performance, remind caregivers how to carry out health care behaviors, and create demand for health services.
• eHealth and information communication technologies (ICTs), ranging from interactive Internet web sites to text messaging via mobile phone, leverage the growing access to ICTs to improve decision-making and performance by providers and clients and facilitate communication in places where it was not possible previously.

Spotlight on Job Aids

URC is widely recognized for developing technically sound, culturally relevant, visually attractive, and effective job aids: tools that improve health workers’ performance of tasks, such as a nutritional assessment, or caregivers’ health care behaviors. such as preparing supplementary foods for young children. Job aids and other materials can remind people how to take action correctly, help them decide what action to take, trigger when to take an action or when not to, and reduce errors and uncertainty. For health workers, job aids reduce training time (training workers to recall information from memory takes longer than training them to follow a job aid), reduce variations in carrying out tasks, and often allow tasks to be shifted to lower-cadre workers without impairing performance.

For example, URC and UNICEF developed the Community Infant and Young Child Feeding (IYCF) Counselling Package. Available in English and French, the package contains a set of job aids for programming and capacity development in IYCF.

In Benin, URC developed and tested job aids and training to enable task-shifting of counseling from nurse-midwives to nurse aides without sacrificing the quality of counseling. An evaluation found that the use of job aids by skilled providers increased the number of pregnancy and newborn care messages provided to clients as well as clients’ retention of these messages. The job aids, when used by nurse aids, ensured counseling performance and effectiveness comparable to or better than those of skilled providers. Read more about the job aids and the evaluation in the article Task Shifting in Maternal and Newborn Care.

Other Channels, Tactics, and Strategies

In the United States

URC and prime contractor ICF Macro are collaborating to prevent and reduce underage alcohol use through the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Underage Drinking Prevention Education Initiatives (UADPEI) project.The UADPEI project provides state-of-the-art health communications support to SAMHSA by strategically developing targeted and innovative products to prevent underage drinking.

For example, the project helped develop the iPad application Me, You, and Wally  Bear: Building Blocks for a Healthy Future, which facilitates positive interactions between children ages three- to six-years old and their parents/caregivers. Research has shown that a solid foundation of positive communication habits, health behaviors, and social skills can help children live healthy lifestyles and avoid alcohol and other drug use as they grow older. 

The UADPEI project also developed and maintains three websites:

• Building Blocks for a Healthy Future - Helps parents, caregivers, and educators promote the healthy social and emotional development of young children in order to prevent substance abuse.
• Too Smart to Start - Educates youth and teens about the risks of alcohol use.
• Stop Alcohol Abuse.gov - Serves as a gateway to comprehensive research and resources on underage drinking prevention.
  

The project has also developed an interactive touch screen display for the US Drug Enforcement Administration Museum's "Target America" traveling exhibit; created a public service announcement that aired in New York City's Times Square and garnered over 17 million estimated impressions; and coordinated over 6,000 town hall meetings, which are helping communities move from raising awareness about underage drinking as a public health issue to taking actions that will measurably prevent it.

Internationally

A local theater group uses drama to demonstrate and encourage malaria-reducing behaviors in a Ghanaian village. Photo by former URC employee Dr. Steve Harvey.

The Integrated Family Health Program (PISAF) in Benin implements communications campaigns using community radio, theater, and music. The Promoting Malaria Prevention and Treatment (ProMPT) project in Ghana also uses community theater to motivate villagers to practice malaria-reducing behaviors. Using ongoing monitoring through behavior-based indicators for quality improvement, the dramas' script and key messages are modified to make them more appealing and actionable.

The South Africa TB Program uses TV, radio, sports events, print materials, community mobilization, advocacy, and health worker training to address the many influences on people's high risk of TB transmission, including a compelling video called "We Beat TB" (watch below).

In the Philippines, USAID's Health Promotion and Communication Project (HealthPRO), in collaboration with the Philippines Department of Health, used mobile technology to disseminate safe motherhood messages through the “Ask Ma’am Melba” interactive voice response (IVR) system pilot. The system enabled rural and urban clients to easily retrieve free, life-saving maternal health information in the form of pre-recorded voice prompts from “Ma’am Melba,” a virtual midwife. Users simply texted the keyword “Melba” on their mobile phones to pre-identified numbers, and the system automatically returned the call (at no cost).

Over the course of a two-week pilot, the "Ask Ma'am Melba" IVR provided just-in-time information to nearly 800 clients who used the service to learn new information and act on it. Fatima, one of the callers, was nine months pregnant with her first child and plagued with headaches and dizziness. She texted Ma’am Melba for advice and received a call back advising her to “Go immediately to hospital.” She went to the Bulacan Medical Center, where she was diagnosed with pre-eclampsia, a medical condition characterized by high blood pressure and significant amounts of protein in the urine that, if left untreated, can lead to life-threatening seizures. Fatima received treatment immediately and delivered a healthy baby boy.

Through the Malaria Control in Cambodia (MCC) project, village malaria workers use a variety of job aids in discussisng malaria with families and providing prevention and treatment services and products. The article Increasing Access to Early Malaria Diagnosis and Prompted Treatment in Remote Cambodian Villages, co-authored by URC staff, reports on this program, which doubled (from less than 30% to almost 60%) of the proportion of confirmed malaria cases treated by village malaria workers.

Flipchart image of a man suffering from fever and chills due to malaria. Village malaria workers use the flipchart to support interpersonal communication on malaria prevention and treatment messages in Cambodia.

Through the USAID Health Care Improvement Project in Guatemala, health workers in clinics received text messages on their mobile phones to remind them of the principles of quality health care. In formative research, health workers said they would like to receive messages that 1) motivated them and promoted quality performance, 2) were sent no more than three times a week during lunch or before work, and 3) clearly identified the Ministry of Health (MOH) as the source. Mid-campaign assessments found that text messages helped create a sense of connection between public sector health workers and the MOH: Health workers 1) felt as though the MOH remembered them, 2) wanted to continue receiving messages regularly that included information on events, health, emergency alerts, and MOH norms. An end-of-campaign telephone survey found that 80% of health workers reacted positively to the messages; 82% found the messages helpful; and 39% shared them with co-workers.

         

Current Projects

HIV and AIDS Comprehensive Care Initiative (HACCI)
Funded By: US Centers for Disease Control and Prevention through the President's Emergency Plan for AIDS Relief
Project Duration: 2008 to present

Building Human Resource Capacity to Support Prevention, Care, and Treatment: Strategic Information and Other HIV/AIDS Programs
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2008 to present

Essential Obstetric and Newborn Care (EONC) Networks Project in Cotopaxi, Ecuador
Funded By: US Agency for International Development
Project Duration: 2009 to present

South Africa Tuberculosis Program
Funded By: US Agency for International Development
Project Duration: 2009 to present

Increasing Access to HIV Testing and Counseling
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2006 to present

Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)
Funded By: Subaward from Emory University with funding from the Bill & Melinda Gates Foundation
Project Duration: 2009 to present

Technical Assistance and Support Contract 3: Global Health (TASC3 Global Health)
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Afghanistan
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Ethiopia
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Guatemala
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Global
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Mali
Funded By: US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Nicaragua
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Tanzania
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Uganda
Funded By: US Agency for International Development
Project Duration: 2007 to present

Underage Drinking Prevention Education Initiatives (UADPEI)
Funded By: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention
Project Duration: 2009 to present

PrevenSIDA
Funded By: United States Agency for International Development
Project Duration: 2010-present

TB CARE II
Funded By: United States Agency for International Development (USAID)
Project Duration: 2010 to present

USAID Primary Health Care Project in Iraq (PHCPI)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

Partnership for the Community Management of Child Health (Prise-C)
Funded By: US Agency for International Development (USAID)
Project Duration: 2010 to present

Diagnosis and Management of Severe Febrile Illness: Tibu Homa
Funded By: US Agency for International Development
Project Duration: 2011 to present

Control and Prevention of Malaria (CAP-Malaria) Project
Funded By: US Agency for International Development Regional Development Mission for Asia (USAID RDMA)
Project Duration: 2011 to present

Georgia Tuberculosis Prevention Project (TPP)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

Nutri-Salud: Community Nutrition and Health Project
Funded By: US Agency for International Development
Project Duration: 2012 to present

Past Projects

Malaria Control in Cambodia (MCC) Project
Funded By: US Agency for International Development
Project Duration: 2007-2011

USAID's Health Promotion and Communication Project (HealthPRO)
Funded By: US Agency for International Development (USAID)
Project Duration: 2007–2012

Benin Integrated Family Health Project (Projet Intégré de Santé Familiale, PISAF)
Funded By: US Agency for International Development and the President’s Malaria Initiative through USAID for malaria activities
Project Duration: 2006–2012

Promoting Malaria Prevention and Treatment (ProMPT)
Funded By: US Agency for International Development through the President’s Malaria Initiative
Project Duration: 2009-2013

USAID Health Care Improvement Project (HCI) | Namibia
Funded By: US Agency for International Development
Project Duration: 2008-2012

Infant and Young Child Nutrition (IYCN)
Funded By: US Agency for International Development
Project Duration: 2006-2011

Integrated Infectious Disease Capacity Building Evaluation (IDCAP)
Funded By: Accordia Global Health Foundation
Project Duration: 2008-2012

Food and Nutrition Interventions (NuLife)
Funded By: US Agency for International Development through the President’s Emergency Plan for AIDS Relief
Project Duration: 2008-2011

Multi-Sector Alliance Program (Alianzas II)
Funded By: US Agency for International Development through RTI International
Project Duration: 2010 to 2012

Nongovernmental Organization Service Delivery Program in Bangladesh
Funded By: US Agency for International Development/Bangladesh
Project Duration: 2002-2006

Benin Integrated Family Health Project (PROSAF)
Funded By: US Agency for International Development/Benin
Project Duration: 1999-2006

El Salvador Strengthening Health Project Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development
Project Duration: 2006–2009

Eritrea Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development/Eritrea
Project Duration: 2003–2006

Partnerships for Health Reform Project and Partners for Health Reformplus
Funded By: US Agency for International Development
Project Duration: 1995–2005

Primary Health Care Operations Research Project (PRICOR) I and II
Funded By: US Agency for International Development
Project Duration: 1981–1991

Technical Information on Population for the Private Sector
Funded By: US Agency for International Development
Project Duration: 1985-1990

Water and Sanitation for Health
Funded By: US Agency for International Development
Project Duration: 1988–1994

Quality in Health (Calidad en Salud)
Funded By: US Agency for International Development
Project Duration: 1999-2009

Haiti Voluntary Agencies for Child Survival Project
Funded By: US Agency for International Development
Project Duration: 1989-1995

Jamaica Adolescent Healthy Lifestyles (JA-STYLE)
Funded By: US Agency for International Development/Jamaica
Project Duration: 2005-2010

Malawi Support to AIDS and Family Health Project
Funded By: US Agency for International Development
Project Duration: 1994-1998

Mozambique Primary Health Care Support Project
Funded By: US Agency for International Development
Project Duration: 1994-1999

Rapid Expansion of Nutritional Recuperation Services for Malnourished Children in Nigerien Facilities
Funded By: American Jewish World Services, US Agency for International Development Office of Foreign Disaster Assistance, and UNICEF
Project Duration: 2005-2007

Peru Strengthening Health Institutions Project, MaxSalud Component
Funded By: US Agency for International Development/Peru
Project Duration: 1994-1999

Quality Assurance Project (QAP) I, II, and III
Funded By: US Agency for International Development
Project Duration: 1990-2008

Romania Health Care Reform Program
Funded By: US Agency for International Development /Romania
Project Duration: 2005-2008

PreventAIDS
Funded By: US Agency for International Development
Project Duration: 2005-2008

TASC II Tuberculosis/South Africa
Funded By: US Agency for International Development/South Africa
Project Duration: 2004-2009

Development of a Population and Family Health Improvement Project in the Solomon Islands
Funded By: Asian Development Bank
Project Duration: 1994-1995

Campaign for Our Children Media Initiative
Funded By: Maryland Governor’s Council on Adolescent Pregnancy
Project Duration: 1997

Communications Training and Capacity Building
Funded By: US Department of Health and Human Services, Office for Substance Abuse Prevention
Project Duration: 1989-1992

Career Development Center for Drug Abuse Administration
Funded By: National Institute on Drug Abuse
Project Duration: 1975–1980

CSAP Communications Team (CCT)
Funded By: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (CSAP)
Project Duration: 1992-2002

Department of the Navy: Drug Demand Reduction Program
Funded By: Tennessee Valley Authority
Project Duration: 1993-1995

Education Programs of the National Heart, Lung and Blood Institute and the National Heart, Lung and Blood Institute Campaign
Funded By: US National Institutes of Health, National Heart, Lung, and Blood Institute
Project Duration: 1987–1993 and 1997–2002

Health Communications Initiative for the Prevention of Underage Alcohol Use
Funded By: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
Project Duration: 2004-2009

Substance Abuse and Mental Health Administration Hispanic/Latino Initiative
Funded By: US Substance Abuse and Mental Health Administration
Project Duration: 1999-2005

National Center for Alcohol Education State Trainer Development Workshops
Funded By: US National Institute for Alcohol Abuse and Alcoholism
Project Duration: 1973–1981

National Drug Abuse Center for Training and Resource Development
Funded By: US National Institute for Alcohol Abuse and Alcoholism
Project Duration: 1979-1982

Technical Assistance for the National School Resource Network
Funded By: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention
Project Duration: 1979-1982

Naval Alcohol Rehabilitation Center Project
Funded By: US Department of the Navy
Project Duration: 1983-1986

National Clearinghouse for Alcohol and Drug Information (NCADI)
Funded By: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention
Project Duration: 1987-2007

National Clearinghouse for Alcohol Information
Funded By: US National Institute for Alcohol Abuse and Alcoholism
Project Duration: 1984-1987

New and Emerging Issues Project
Funded By: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention
Project Duration: 1992-1998

UNICEF Malawi and New York
Funded By: UNICEF
Project Duration: 2008-2010

Substance Abuse and Mental Health Services Administration Conference Exhibit Program
Funded By: Substance Abuse and Mental Health Services Administration
Project Duration: 2003-2006

Too Smart To Start
Funded By: US Department of Health and Human Services (SAMHSA), Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (CSAP)
Project Duration: 2001-2004

Weight Control Information Network
Funded By: US National Institute of Diabetes and Digestive and Kidney Diseases
Project Duration: 1994-2005

Technical Assistance and Support Contract 2 (TASC2): Global Health
Funded By: United States Agency for International Development
Project Duration: 2004–2009

Technical Assistance and Support Contract (TASC2) Tuberculosis
Funded By: United States Agency for International Development (USAID)
Project Duration: 2004–2009

Benin Muskoka
Funded By: United Nation’s Population Fund (UNFPA)
Project Duration: July–December 2012