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Behavior Change Communication
Communicating to clients and patients effectively. This chapter reviews techniques involved in effective communication What is behavior change communication? • • This is a strategy, which refers to the systematic attempt to modify/influence behavior, or practices and environmental factors related to that behavior, which indirectly or directly promote health, prevent illness or protect individuals from harm. • What is communication? • This is a process of transmitting and receiving information on a particular topic between people • It is a process not a product • It is not simply producing a brochure, a poster or a social drama Types of communication • Intra-personal: Communication with oneself • Interpersonal: Face to face communication between individuals • Mass communication: An individual communicating with many people. Such as through radio. • Organizational communication: Communication among groups or within groups
Injection safety saves lives




Injection prescribers
Therapeutic injection overuse

1. Prescribe oral medication wherever possible

2. If prescribed an injection, ask if medication can be given orally instead

Reuse of injection equipment without sterilization

Patients and population

3. Demand that a syringe and needle be taken from a new, sealed and undamaged package

4. Use a syringe and needle from a new, sealed and undamaged packet for every injection

Injection providers
Unsafe sharps collection

5. Without recapping, place syringes and needles in a safety box immediately after use

Unsafe management of injection waste

6. Manage injection waste safely and appropriately

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Interpersonal Communication and Counseling (IPCC) Interpersonal communication • This is a two-way communication process i.e. a dialogue • Good interpersonal communication skills are essential in order to enhance client/provider interactions.

The Role of IPCC in Reducing Injection Overuse • It’s the key communication component in influencing behavior change • It facilitates the decision making process • It creates a forum for clarification of issues • It complements, reinforces and elaborates messages presented from other sources of information

Elements of Interpersonal Communication 1. Foundation • Non - judgemental • Observe Non verbal communication • Respect • Empathy 2. Good Interactions • Reassurance • Two-way
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• Listening • Involvement • Feedback • 3. Knowledge Ideas/sharing experiences Understanding Perceptions, attitudes and values Perception: • To perceive is to become aware directly through the senses, to achieve understanding Factors that affect perceptions • Age • Gender • Social class • Ethnic background • Life experiences Values: • These are the social principles, goals and standards held by an individual or group, that influence the individual's daily life activities • They are influenced by family, religion, friends, education, cultural, and personal experience Attitude: This is a state of mind or a feeling. It forms the basis of most of our actions. It is the mental position individuals take in relation to the world.

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Rights of the Clients Every client has rights in counseling (Client-Provider Interaction). These are: Information: To learn about the benefits and availability of different forms of treatment Access: To obtain services regardless of sex, creed, color, marital status or location Choice: To decide freely whether to have an injection or oral formulations Safety: To be able be assured of safety of injection practices Privacy: To have a private environment during counseling or services Confidentiality: To be assured that any personal will remain confidential information

Dignity: To be treated with courtesy, consideration and attentiveness Comfort: To feel comfortable when receiving services. Opinion: To express views on the services and treatment offered •

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Interpersonal Communication Skills In order for health workers to communicate effectively, they require to have several types of communication skills. These are: • Effective listening skills • Observation skills • Rapport establishment • Questioning skills • Paraphrasing • Reflecting and, • Summarising • Observation skills Rationale: Assist in understanding how they feel in regard to injection practices. Gives deeper insights into true thoughts and feelings People communicate through: Voice, tone, body movement, touching, facial expression, eye Contact. Clothing, Houses, furniture, cars etc reflect peoples attitudes and values Areas of observation Physical: body-build, physical appearance, level of energy Emotional: facial expression, the eyes, the lips if tight or relaxed posture, body stance, grooming Interpersonal: How she relates to you positively, negatively, neutrally

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THE SKILL OF LISTENING Hearing alone is not listening! Steps of listening Know what you are listening for Listen to specific content (who, what, where, when, why) Suspend your personal judgment Resist distractions, thoughts, imaginations which take your attention from the client What are the goals of questioning and listening? • Brings out specific information • Increase your awareness of the client’s feeling • Give a degree of control to the client • Communicate your interest to the other person • Encourages the client to talk. • • Types of questions Different types of question serve specific roles. • Close ended: Specific answer intended o "How many children do you have?" • Open ended: To learn about clients' feelings, beliefs, knowledge o "What have you heard about injection safety?" • Probing: Follow-up in response to statement o "Can you tell me more about why you think injections are more effective?" • Leading: Not appropriate "Don't you think you should try the injection?
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• Reality-based questions like: “What would keep you from formulation?”




Establishing rapport Establishing a relationship that is harmonious or sympathetic. It implies building trust, having each others’ best interest in mind and having mutual respect. Importance of rapport in client-provider interaction • Establishing rapport is a critical step in effective communication. • It’s enables clients/patients to express themselves adequately. • When rapport is well established, information is well understood, and clients are likely to comply with advice.

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Counseling: This is face-to-face communication between two people whereby one person helps another person make a decision or plan and act on it. • Steps in counseling The counseling process involves following methodologically 6 key steps which are summarized by the acronym “GATHER” •

The practical counseling process: • Six Important Steps in Counseling: “GATHER” 1. GREET the clients (establishing rapport) 2. ASK clients (gathering information) 3. TELL (provide information) 4. HELP the client make informed decision 5. EXPLAIN to the client all the details 6. RETURN/REFER/REALITY CHECK (Return visits or referrals should be planned where necessary)

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Both provider and client play roles in client-centered counseling. Clients’ / patients’ roles: Ways clients can improve the quality of their interactions with health care providers and their ability to make wise decisions: 1. Expect good care • Repeat their request for information if the provider does not respond 2. Elicit information • Request information about their options • Ask questions • Ask providers to repeat or clarify information that they do not understand • Check their own understanding of information and instructions 3. Disclose information • Respond fully to providers’ questions • Volunteer information about their preferences, needs, and problems • Express fears, concerns and worries • Openly discuss their personal situation 4. Make thoughtful decisions • Accept it is their right and responsibility to choose a method • Understand how their personal circumstances and needs affect the decision • Discuss the advantages and disadvantages of options to help chose the best one • Ask for instructions and any other help they may need to carry out the decision
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The health provider’s role: Client-centered counseling requires providers, building on their personal communication skills, to achieve interactions with clients that: 1. Establish rapport: • Assure privacy and confidentiality • Be positive and encouraging • Encourage clients to ask questions and share information • Listen and observe what clients say and do • Use a friendly tone of voice and attentive body language to convey warmth 2. Focus on the individual: • Respond first to the client’s stated need, interest, or question • Help the client understand how unsafe injections may affect ones life. • Respond to the client’s concerns, including rumors, respectively and constructively. 3. Communicate medical information and facts on injection safety clearly • • • • Use simple, non-technical language Do not give irrelevant or too much information at once Encourage questions and make time for them Check that the clients/patient understand benefits of oral medication and dangers of unsafe injections • Know their own biases about treatments options (orals or injectable) • Use memory and job aids to guide and inform the interaction

4. Advise and encourage clients to choose non injectables options

• Let clients know they have options and rights to ask for oral medications. 5. Empower clients/ patients • Help clients/patients to understand the dangers of unsafe injections and their rights to express their preference for oral medications.

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Steps to Behavior Change These are the ideal steps one follows towards behavior change. They may apply to health workers or community members Knowledge: • One first learns about a new behavior (injection safety practices) • Recalls messages on Injection Safety and understands meaning of the messages • Can name Injection safety strategies and practices Approval: • One then approves of the new behavior (Injection safety Strategies) • Responds favorably to injection safety messages • Discusses injection safety with personal network (professional, colleagues, family and friends) • Thinks professional colleagues, family, friends and community approves of Injection safety practices. Intention: • One then believes this behavior is beneficial to them and intends to adopt it. • Recognizes that Injection safety strategies can meet a personal need • Intends to adopt injection safety practices Practice: • One then attempts new behavior and continues to practice. (Practices proposed under each strategy in injection safety) Advocacy • One can then promote the new behavior through their social or professional networks as a satisfied practitioner. • Experiences and acknowledges personal benefits of adopting behaviors that enhance injection safety.
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How we frame our messages depends on the stage our intended audience is in the Steps to Behavior Change

NOTE: • Not all people go through all the steps systematically as described above. • Identify where your audience is on the Steps to Behavior Change and help them move on to the next step!!! Advocacy Unfulfilled Practice Communication Intention Needs Approval Knowledge Some factors that influence behavioral change: • • • • • • • • Physical stimuli Rational stimuli Skills Knowledge Social cultural factors Demographic-age, sex, etc Previous experiences Attitudes

Standards for Behavioral change communication. (BCC):

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Achieving behavior change is central to attaining adherence to Injection safety and appropriate waste management. BCC is a cross cutting intervention and therefore its components must be incorporated in all the proposed strategies addressing injection safety. A comprehensive Behavioral change communication strategy need to address the following areas: • The unnecessary prescription of injections, with a view to promote prescription of oral medication wherever possible. The prescribers should explain the various treatment options available to the client and encourage use of non injectable options. • Dissemination to all health facility levels and orientation on the use of standard treatment guidelines is necessary to support sustained behaviour change in the reduction of injection prescriptions. • To advocate for review of essential drug list with a view of reducing unnecessary injectable medications and increasing oral medication. • The patients demand for injections or acceptance of injections without questions. This can be tackled by empowering clients/communities to ask if medication can be given orally instead if an injection has been prescribed. • Identify and train community own resource persons for positive action in educating and giving continuous support to its members. Communities should be sensitized on their rights on Injection Safety, risks of unnecessary injections, and dangers of injection reuse. Regular well targeted Community campaigns for rational use of injections should be organized.
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• Unsafe sharps collection which leads to accidental needle prick injuries can be supported by communication targeting providers to Place syringes and needles in a safety box immediately after use without recapping. • Messages focusing on poor injection waste disposal practices should be designed to promote safe and appropriate management of waste. • Training of health workers on the newly developed injection safety policy, standards and guidelines. Advocacy: This should be directed to all stakeholders through media, stakeholder workshops, meetings etc all meant to build support for injection safety. Advocacy to mobilize resource, support and build partnerships across sectors should be identified and followed. Communication strategies: some of the communication strategies targeting Health workers (prescribers, providers, auxillary staff) and communities that can be applied in behaviour change strategies include: • Program communication; IEC Materials in health facilities (Posters, Leaflets, SOP charts, etc) • Mass media campaign to promote preference for oral medication • Influential talks by religious and opinion leaders, professionals.

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Evidence based community interventions (Entertainment education) Peer learning and personal testimonies. etc

Points to remember!

1. Elements of IPCC 2. Rights of client 3. Six important steps in counseling (gather) 4. Types of questions 5. Provider’s role in counseling 6. Client’s role in counseling 7. Behavioral change communication standards


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