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The Social Ecological Model (SEM) is a theory-based framework for understanding the multifaceted and interactive effects of personal and environmental factors that determine behaviors, and for identifying behavioral and organizational leverage points and intermediaries for health promotion within organizations. There are five nested, hierarchical levels of the SEM: Individual, interpersonal, community, organizational, and policy/enabling environment.
Communication for Development (C4D) is a systematic, planned, and evidence-based approach to promote positive and measurable behavioral and social change. C4D is an approach that engages communities and decision-makers at local, national, and regional levels, in dialogue toward promoting, developing, and implementing policies and programs that enhance the quality of life for all. The C4D approach uses information- and dialogue- based processes and mechanisms to empower populations, especially those that are marginalized and vulnerable, and to facilitate and build collective efficacy and actions. C4D aims to strengthen the capacity of communities to identify their own development needs, assess the options and take action, and assess the impact of their actions in order to address remaining gaps. C4D approaches and tools facilitate dialogues between those who have rights to claim and those who have the power to realize these rights.
Figure 2 shows the communication strategies that make up the C4D approach:
(1) Behavior change communication (BCC);
(2) social mobilization (including strengthening an enabling media and communication environment);
(3) social change communication; and
These strategies correspond to specific levels of the SEM where they are most effective. It is important to note that the different approaches (right side tabs) can apply to levels other than the one they are next to, for example, the advocacy approach can also be used at the community or organizational levels.
The policy/enabling environment level of the SEM consists of policy, legislation, politics and other areas of leadership that influence health and development. A strategy used to address this level of the social system is advocacy. Advocacy is an organized effort to inform and motivate leadership to create an enabling environment for achieving program objectives and development goals. The purpose for advocacy is (1) to promote the development of new policies, change existing governmental or organizational laws, policies or rules, and/or ensure the adequate implementation of existing policies (2) to redefine public perceptions, social norms and procedures, (3) to support protocols that benefit specific populations affected by existing legislation, norms and procedures, and/or (4) to influence funding decisions for specific initiatives.
There are three common types of advocacy:
Policy advocacy, to influence policymakers and decision makers to change legislative, social, or infrastructural elements of the environment, including the development of equity-focused programs and corresponding budget allocations;
Community advocacy, to empower communities to demand policy, social, or infrastructural change in their environment,
Media advocacy, to enlist the mass media to push policymakers and decision makers toward changing the environment.
Social mobilization recognizes that sustainable social and behavior change requires collaboration at multiple levels, from individual to community to policy and legislative action, and that partnerships and coordination yield stronger impacts than isolated efforts. Key strategies of social mobilization include using advocacy to mobilize resources and change inhibiting policies, media and special events to raise public awareness and create public spheres for debate, building and strengthening partnership and networks, and motivating community participation.
Behavior Change Communication
Behavior change communication (BCC) is the strategic use of communication to promote positive health outcomes. BCC is a theory-based, research-based, interactive process to develop tailored messages and approaches, using a variety of population-appropriate communication channels, to motivate sustained individual- and community- level changes in knowledge, attitudes, and behaviors. Formative research is used to understand current levels of knowledge, attitudes, and behaviors among individuals in a specified population in order to develop communication programs that move those individuals along a continuum of change (or through stages of change) toward the desired positive behavior(s).
Using the BCC approach can help to:
Stimulate community dialogue and raise awareness about the problem
Increase knowledge, for example, about the importance of exclusive breastfeeding or hand washing with soap
Promote attitude change, for example, about the risks associated with childhood asthma
Reduce stigma, for example, around exclusive breastfeeding
Create demand for information and services
Advocate with policymakers and opinion leaders toward effective approaches to reducing death violence and poverty
Promote services for prevention and control of chronic diseases
BCC is an essential part of comprehensive prevention and control programs that include both services (e.g., health, medical) and commodities (e.g., vaccines, oral rehydration packets, VIP latrines). Before individuals and communities can reduce their level of risk or change their behaviors, they must first understand basic facts about MNCH health risks, adopt key attitudes, learn a set of skills (e.g., exclusive breastfeeding, care-seeking at appropriate times, hand washing with soap) and be given access to appropriate products and services. They must also perceive their environment as supporting behavior change and the maintenance of safe behaviors, as well as supportive of seeking appropriate prevention, treatment and support.
How to Use the Social Ecological Model for Planning a Strategic C4D Intervention
Since individuals exist in a social ecological system, changing individual-level behaviors and creating new social norms requires creating an enabling environment, that is, facilitating change and removing bottlenecks that inhibit change at the household, community, organizational, and policy levels. For example, if a program’s goal is to decrease the number of children with asthma who visit the emergency room or miss school, then:
Parents and caregivers must understand why it is important to have their child's asthma treatment and be motivated to seek and demand an adequate asthma plan for their child.
Parents, caregivers, and schools must have easy access to the asthma plan for their child.
3) health facilities and/or community health workers must be trained and equipped to provide emergency asthma care.
(4) communities must embrace and own the importance of childhood asthma and demand programs that address the problem, and create a social norm around asthma treatment.
Program managers and program planners should use the SEM:
To understand the complexity of, and possible avenues for addressing, the health problem.
To prioritize resources and interventions that address the multiple facets of the problem, remove bottlenecks, and create an enabling environment for sustained behavior and social change.
Social mobilization (SM) is a continuous process that engages and motivates various inter-sectorial partners at national and local levels to raise awareness of, and demand for, a particular development objective. These partners may include government policy makers and decision-makers, community opinion leaders, bureaucrats and technocrats, professional groups, religious associations, non-governmental organizations, private sector entities, communities, and individuals. This communication approach focuses on people and communities as agents of their own change, emphasizes community empowerment, and creates an enabling environment for change and helps build the capacity of the groups in the process, so that they are able to mobilize resources and plan, implement and monitor activities with the community.
Engagement is usually through interpersonal communication (i.e., face-to-face dialogue) among partners toward changing social norms and accountability structures, providing sustainable, multifaceted solutions to broad social problems, and creating demand and utilization of quality services. Other channels and activities for SM may include mass media awareness-raising campaigns, advocacy with community leaders to increase their commitment to the issue, and activities that promote broad social dialogue about the issues, such as talk shows on national television and radio, community meetings, traditional participatory theater performances, home visits, and leaflets. The outcomes are usually oriented toward developing a supportive environment for decision-making and resource allocation to empower communities to act at the grassroots level.
Social Change Communication
Social change communication (SCC) is a purposeful and iterative process of public and private dialogue, debate, and negotiation that allows groups of individuals or communities to define their needs, identify their rights, and collaborate to transform the way their social system is organized, including the way power is distributed within social and political institutions. This process is usually participatory and is meant to change behaviors on a large scale, eliminate harmful social and cultural practices, and change social norms and structural inequalities.
While social mobilization (above) focuses on creating and sustaining action-oriented partnerships to create an enabling environment for positive health, SCC focuses on creating ownership of the process of change among individuals and communities. The emphasis of SCC is on creating empowered communities that know and claim their rights and become their own agents for changing social norms, policies, culture and environment (e.g., healthcare delivery infrastructure).
Excerpts from MODULE 1: What are the Social Ecological Model (SEM), Communication for Development (C4D)? by UNICEF (2009)
The C4D approaches are interrelated and interactive and using them in a well-planned program produces a synergistic effect. Simple preventive actions by the individual, family and community, stimulated by behavior change communication (BCC), are the most immediate means for improving maternal, newborn, and child health. Advocacy strategies can pave the way for new laws or change a policy that may be impeding change. Multi-level approaches help shift community and organizational norms to ensure that behavior changes are sustained over time. Below is a description of each of the C4D approaches.