Social Mobilization and Behavior Change for Pandemic Influenza Response: Planning Guidance

"The pandemic situation poses many challenges to achieving wide scale behavior change to reduce transmission and mitigate impact. For that reason, it is unlikely that communication objectives can be met simply by conveying key information to the public at large. Instead, multiple communication approaches are needed at different levels, involving partners ranging from high-level leaders and policy makers to sub-national health officials and personnel, to local leaders and stakeholders, to the particular communities affected by the pandemic."

The purpose of this 24-page document is to provide a framework and guidance to planners for developing country-specific social mobilisation and behaviour change communication (BCC) strategies for the global pandemic of type A (H1N1) influenza. Both technically sound communication principles and recent experience in several countries have informed this overview of strategic communication as it applies to pandemic influenza in low- and middle- income countries.

The document is the product of ongoing collaboration between the United Nations Children's Fund (UNICEF) and AI.COMM, a United States Agency for International Development (USAID) project managed by the Academy for Educational Development (AED), to design and implement effective communication programmes in developing countries - first for avian influenza and more recently for pandemic influenza preparedness and response. The approaches and content reflected here support the current recommendations on pandemic influenza of the World Health Organization (WHO) and other international health partners.

Strategies explored in the report incorporate these key communication elements of the pandemic response:

• Communication objectives - Regardless of which specific goals are identified (e.g., minimise panic; help governments provide credible information), the strategy should describe how communication will use a combination of advocacy, social mobilisation, and BCC through a variety of channels to achieve each objective.
• Key participant groups - One emphasis here is on involving marginalised and hard-to-reach groups in communication planning and implementation so that they become active participants, not just passive recipients of information. Involvement not only helps to adapt communication strategies and messages to the local context, but also connects the perspective of minorities and the hard-to-reach to upstream policy advocacy regarding pandemic response issues - for example, steps to take to reduce inequities in economic impact.
• Desired and feasible behaviours - In May 2009, WHO and UNICEF disseminated 8 key behaviours (see Box 1 within the document) for helping reduce transmission and lessen the health impact of H1N1 influenza. "With these behaviors as a starting point, it is important to seek wide participation in how these behaviors can be adapted to the local context....Communication plans should include policy advocacy to trigger timely and appropriate decisions by government and pandemic partners to support adoption of recommended behaviors to scale."
• Adapted messages - Rather than developing generic messages based on scientific evidence alone (even if translated into multiple local languages), planners should adapt messages to reflect: local perceptions of disease transmission, feasible and locally relevant calls to action, perceived consequences to performing the behaviour, and emotional appeal.
• Credible sources of information and appropriate channels - Noting that the channels to use during the pandemic are likely to vary widely depending upon how different segments of the population (participant groups) access and use information, this section examines: mass media (television, radio, newspapers, posters, billboards, leaflets), traditional media (folk theatre, puppets, poetry/song, social and religious gatherings), interpersonal communication (household visits, courtyard meetings, health education, social mobilisation, school activities), and new media (cell phones, short message service (SMS), the internet (websites, blogs, Twitter), and telephone hotlines).
• Advocacy - During the response to the pandemic, advocacy can be used with various ministries outside of health (for example, education, child welfare, tourism) to engage them in policy decisions at the national level to help reduce transmission and mitigate the social and economic impact. Advocacy at the sub-national levels is also critical for coordinated planning and implementation to reach to the community level. Examples of these and other types of advocacy are provided.
• Partners for social mobilisation - Before an outbreak occurs, agreements should be made with a few key groups about how they will assist in communicating during the pandemic response. Examples include: civil society organisations and non-governmental organisations (NGOs), religious and community leaders, private health providers and pharmacists, major employers and private industries, and networks such as teachers and student peer groups. "It is particularly important to find groups which can reach and are credible to some of the minorities, socially marginalized and other participant groups identified in the communication strategy. To assure that these groups communicate correct information effectively, specially adapted materials and orientation to their use will be important components of the communication plan."
• Behaviour change communication (BCC) - The role of BCC during the pandemic is to inform and motivate individuals to adopt the behaviours recommended to prevent contracting the H1N1 virus, limit its spread to others, and promote home care of the sick. "One effective way to motivate individuals is to engage popular and trusted personalities in addition to the official government spokespersons as sources of information. Using a combination of mass media, interpersonal communication and traditional media will increase the effectiveness of messages to different participant groups."
• Risk/outbreak communication - Effective communication between health and government authorities and the population takes planning and capacity building, including: identification and training of spokespersons from government and other selected agencies; media training and continued orientation; and - during outbreaks - regular updates to the public from authorities via mass media, maintenance of quality websites and other information sources, regular updates to hard-to-reach groups via pre-arranged communication channels, and monitoring for reach and rumours.
• Research and monitoring - This section covers the topics of research during planning, pre-testing, monitoring, and evaluation. If resources are limited, the suggested focus is on: existing sources of information (such as household surveys); formative research to understand perceptions of risk and feasibility of protective behaviours; pre-testing of communication products and messages; and monitoring the reach of communication channels to key participant groups.

The pyramid in Figure 1 on page 20 of the document illustrates multilevel participation and the relationship between levels, participant groups, and actions to bring about effective communication for pandemic influenza.

Box 3 on page 11 shares consolidated lessons learned extracted from 2 surveys of communication experiences gained from several recent epidemics (full versions of the 2 reports on which these recommendations are based - Silvio Waisbord's "Assessment of UNICEF-supported Communication Initiatives for Prevention and Control of Avian Influenza", March 2008; and Renata Schiavo's "Mapping and Review of Existing Guidance and Plans for Community and Household Based Communication to Prepare and Respond to Pandemic Influenza", January 2009 - may be found here).