Behaviour change: Step by step

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Page context: Agenda magazine > Agenda Magazine 2007 > Behaviour change

No HIV workplace policy or education programme will succeed if it can’t get vulnerable workers to change their actions. Josee Laporte explains how to make change happen

In recent years, a great deal of effort has gone into HIV/AIDS education but, in most cases, it has not been translated into behaviour change. Many workers do not know enough about how HIV is transmitted and therefore do not adequately protect themselves. Others, who may even understand how the virus is spread, continue to persist in their risk-taking behaviour.

Projects focusing only on information and education have thus come increasingly to be seen as insufficient and there has been growing recognition of the need to shift the emphasis towards behaviour change. Sexual intercourse is the main means of transmission of HIV, and it is the individual who decides to have sex or not and to use a condom or not. It is clear therefore that changing the behaviour of the individual must be the paramount means of preventing infections.

Communicating change

The concept of behaviour change communication (BCC) focuses on the need to interact more closely with the people who are to be involved in a behaviour change programme.

Any such programme needs to address the genuine reasons why individuals are adopting risky behaviours and to involve workers in selecting the most appropriate ways to communicate with their peers.

The best media might include a lunchtime radio show, the company newsletter or a session on HIV/AIDS integrated into other regular training schemes – the important point is that the choice depends on the group’s own situation and habits. The BCC approach enables greater ownership and establishes the foundation for sustainable HIV/AIDS programmes supporting people in their behaviour change process.

Why use the workplace?

The workplace allows communication with homogeneous groups that can be reached on a regular basis. Generally people with similar characteristics, such as the same level of education and income, come together in a workplace. This facilitates dialogue and is conducive to effective peer education programmes, where co-workers can engage in discussions with colleagues at any time and support them in their behaviour change process.

Workplace programmes depend on six key elements:

1) A sound policy

2) An HIV/AIDS workplace committee involving management and unions, with a clear mandate, strategy,work plan and
adequate resources

3) A behaviour change programme

4) A network of focal points and peer educators who work closely with the workplace committee

5) Access to voluntarily confidential testing and treatment by referral to community based services

6) An effective performance monitoring plan

The workplace may also provide internal health services, or can be used to build links to community-based services. It is crucial that the means to support behaviour change are readily available and easily accessible to workers. Condoms should be accessible and affordable, and the locations of confidential voluntary counselling and testing facilities should be widely publicised. Workers should also know where to get treatment for sexually transmitted infections, and where to access antiretroviral drugs, as well as care and support services.

Finally, the workplace provides an environment for policy development. Workplace policies and collective agreements should stipulate non-discrimination against workers on the basis of real or perceived HIV status. Explicit non-discrimination policies are essential in creating an enabling environment to tackle HIV, by reducing stigma and encouraging HIV-positive workers to speak openly about their status.

Steps towards change

An effective strategy is not based on assumptions but on clear findings. The first step is to collect information on workers and managers in order to do a formative assessment. Baseline data should be collected using a variety of methods including: a knowledge, attitudes and practices survey administered to workers; focus groups with workers who share common characteristics and in-depth interviews with key information sources, such as medical services staff, union representatives and social workers. Focus groups are very effective methods for collecting information on the reasons why workers adopt specific behaviours and their motivations for change.

Based on the findings of this formative assessment, the next step is to agree on the objectives and activities of the programme. At this stage a wide range of staff including union representatives, human resources managers, occupational health specialists and workers living with HIV/AIDS should come together to develop their own behaviour change strategy and programme.

This process could take several days, in order to make sure all stakeholders are in agreement, and all key findings of the formative assessment are addressed. One of the most effective ways to do it is to convene a one-week workshop with all stakeholders. If it is difficult for employers to release employees for such a long period, the process can be broken down into weekly sessions.

Should the formative assessment be carried out and reveal similar findings in several local workplaces, a number of enterprises in the same sector may choose to get together to develop a sectoral strategy. This will allow the development of tailor-made materials that could be used in several workplaces.

Whatever the grouping, it needs to agree on a strategy with clear objectives. Some workplaces for example have included the objective of increasing the proportion of workers who report being faithful to one partner. Others have aimed to increase the use of HIV counselling and testing services. With objectives agreed, the next stage is to develop customised and gender-sensitive messages.

Making change happen

Change comes about when the selected communication channels are accepted as being the most appropriate for the target group – and individuals identify themselves with the messages of prevention campaigns.

ILO Toolkit
The International Labour Office (ILO) and Family Health International (FHI) have combined their expertise to produce a toolkit offering guidance on behaviour change programming for the workplace.The toolkit is available at www.ilo.org/aids and at the time of writing has been used in 13 countries in Asia and the Caribbean as well as in Anglophone and Francophone Africa.

To make people change, you need to speak to their hearts and minds, and in order to do that you need to know them. People will want to know the key benefits to them of changing behaviour before they will be prepared to shift the new behaviour.

Depending on the target audience, for example, you may need to underline the potential benefits of behaviour change for the well-being of the family and the future of children.

One group of male workers engaging in multiple partnerships and not being regularly tested for HIV developed the message: “No need to guess, take an HIV test and be less stressed”. In this case it was clear that the prospect of peace of mind could motivate the group to change its behaviour by coming forward for voluntary testing. Another key benefit of testing could have been to have access to appropriate treatment in time, in order to prolong life, keep working and support love ones. The key benefit was selected by the target audience itself.

Choosing the right channel

In many cases messages do not achieve their intended goal because they were not sent through the right channel. In the transport sector, stickers, key rings, radio adverts and peer education may be popular channels. All materials should be pre-tested with the target audience and produced in local languages to be better understood.

Peer education is one of the most effective channels for achieving behaviour change. Peer educators are informal leaders who are persuasive and motivated, and who come from the group of workers that is being targeted. They are familiar with the situation of their colleagues because they share similar pressures and aspirations. They know what makes their colleagues vulnerable to HIV and normally find the right words to engage in dialogue with them.

They may themselves be living with HIV and may be a source of hope for workers who still think that HIV is a death sentence. They can play a crucial role in convincing co-workers to get tested and make them understand that antiretroviral drugs taken in time will allow them to live and work longer.

As implementation starts, effective systems should be put in place to monitor the activities and assess their impact on the behaviour of individuals. Data should be collected regularly to allow revisions and adjustments when necessary. Transport unions can play a key role in the development, implementation, revision and adjustment of behaviour change communication programmes and are well placed to ensure the involvement of the workers at every step of the process.

To be as effective as possible, a BCC programme should consider secondary target populations. In the case of a programme targeting transport workers, the programme should also look at the relations with clients and passengers, workers from the hospitality sector and members of the communities around areas where transport workers can be found.

Josée Laporte is programme and operations officer for the ILO Programme on HIV/AIDS and the World of Work (ILOAIDS), International Labour Organization, laporte@ilo.org

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