Communication For Behavioral Impact Research Articles

Tendency to Addiction from the Viewpoints of the Youth and Their Parents Based on the Marketing Model (Com-B), in 2020, Yazd

Introduction: The present research was conducted with the aim of explaining the views of teenagers-the adults and their parents regarding the prevention of drug addiction based on the mixed elements of the marketing model (audience needs, access to services, cost, and communication). Methods: This research was conducted based on a qualitative research method using an exploratory method. 14 teenagers-adults and 10 parents, 24 participants were selected through targeted sampling, from the marginal neighborhoods of Yazd in 2019; the neighborhoods included Maryam Abad, Hassan Abad, and Skan. In total, 2 semi-structured in-depth interviews with parents and 3 focused group discussions were conducted with the presence of teenagers and young people in the neighborhood. In this study, the information, including demographic characteristics, and the results of market analysis were obtained with elements of Communication for Behavioral Impact (COMBI) social marketing model; they were investigated using focus group discussions (FGD) and semi-structured face-to-face interviews. Data were analyzed based on the content analysis method. Results: The qualitative study resulted in 63 codes, 26 subcategories, 4 categories, product, location, cost, and promotion according to the COMBI model structures. Product category or behavioral characteristics, having peace of mind, and seeking independence were mentioned by both groups of parents and the youth as the factors of addiction tendency. But, regarding the cost of addiction, while teenagers and the young people considered the social side effects of drug use, such as losing friends, more important, parents were more concerned about the physical side effects of drugs. Location or environmental and social conditions were important for both groups of parents and the youth. Conclusion: The results showed that although both groups of teenagers-the youth and their parents pointed to the social, environmental, and individual factors of addiction, their intended examples were different in many areas. Parents considered the most important factor in the tendency to drugs addiction to be the structure of the audience's need, having peace of mind, compensating for the sense of deficiencies and the need for independence, and the youth suggested the use of virtual space and creating motivation and awareness campaign to prevent addiction as a suitable method. Perceived costs according to the young people were loss of friends, feeling of rejection, loss of self-confidence, and negative view of others towards addiction. One of the reasons for the tendency towards addiction was mentioned by the young people as the location and easy access to drugs, and the parents said that the suitable place for the tendency towards addiction was having a risky and inappropriate family.

Комунікаційні стратегії місцевого самоврядування для забезпечення реалізації стратегії розвитку територій

The article analyzes the theoretical approach to determining the essence and features of communication strategies as planning communication documents used by local self-government bodies to involve the target audience and the local population in management at the local and national levels. The author defines the standard and distinctive features of communication and communication strategies and outlines the areas of their use. A communication strategy is a document defined as a strategic communication guideline for the planned implementation of informational influence to raise awareness of the planned changes and form appropriate behavior patterns of potential and existing target audiences and target groups of the local community. The expediency of using the complex system approach COMBI (Communication for Behavioral Impact) in developing and implementing communication strategies is substantiated. Careful development and successful implementation of a communication strategy can increase the effectiveness of decision-making by local self-government bodies and contribute to forming the community as a full-fledged subject of local self-government. Emphasis is placed on informativeness, credibility, the accuracy of messages, and the level of their perception by target audiences to evaluate communication strategies. It was established that the structure of the communication strategy should include such elements as compliance with strategic goals, determination of expected behavior, situation analysis, development of messages and their preliminary testing, development of an action plan, explanation of means of control over implementation, monitoring and assessment of impact, development of schedule and implementation plan, as well as determination of resources and budget. The types of communication strategies that can be developed and implemented at the regional level are summarized, and their strategic goals and hierarchical structures are supplemented. The author’s classification of communication strategies according to the following characteristics is presented: type of actor, goal, region, sector, and influence. Keywords: communicative interaction, public administration bodies, communication strategies, development of local self-government, local community, development strategies and programs, components of communication strategies, types of communication strategies.

Development of a complex intervention package for dengue prevention

Introduction: Complex interventions are widely used in public health practices with noteworthy health impacts. Communication for Behavioural Impact (COMBI) plan is an effective method directed at enacting behaviour change to benefit health and social development which encourage precise behavioural outcomes and is effective in planning a behavioural change for dengue control. The aim of this study was to develop an intervention package to change the behaviour to prevent dengue in one of the highest dengue-endemic areas of Sri Lanka.Methods: The development of the intervention package was formulated according to the two phases, the ‘Theoretical phase’ and ‘Modelling phase’ of the framework for ‘Developing and Evaluating Complex Interventions’. World Health Organization’s 10 key steps in planning COMBI strategies were followed in order to develop the present intervention package. A situational market analysis was conducted in the highest dengue-endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO) for the COMBI plan. The development of the COMBI plan was conducted using the mixed methodological approach including quantitative and qualitative designs.Results: The overall goal of the COMBI plan was to decrease the morbidity and mortality due to dengue illness by improving the dengue prevention behaviours among householders. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce, Reuse and Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies of intervention package were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, and point of service promotion during follow-up.Conclusion: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.

A Conceptual Design for COMBI Dengue Prevention based on an Integrated Psychology and Persuasive Technology Models

Dengue prevention is the best way to prevent dengue outbreaks, as the tagline goes, “prevention is better than cure”. But the challenges lie on sustaining the preventive activity among the community, which commonly only takes place periodically, i.e. when they are dengue outbreaks, with the presence of health officers under the Communication for Behavioral Impact (COMBI) campaign. In this study, a behaviour change model based on the Transtheoretical Model (TTM) and trigger elements derived from the Fogg Behaviour Model (FBM) is proposed to sustain a community in carrying out preventive activities to prevent dengue. Furthermore, the intervention strategy is added to connect the TTM and FBM. In addition, an interview with the community leader, from the community which used to be a hotspot for dengue, and a survey with its residents are performed to give further insights into the development of the proposed model.

Communities' Perceptions on Covid-19 Health Risk Communication and Behaviour Change: A Study of Communities' Engagement during the Covid-19 Pandemic in Uasin Gishu County, Kenya.

The aim of the study is to investigate the communities’ perceptions on health risk communication on covid-19 prevention, treatment and management in Uasin Gishu County, Kenya. The study adopted a social constructivist-interpretive philosophical worldview and a qualitative-case study design. The target population comprised the ministry of health representatives, communities' elders (both men and women), men and women, health workers (doctors, nurses, and public health workers), youth and youth leaders, media & business community representatives. A sample size of 60 participants was selected. Purposive, quota and snowball sampling techniques were used. Data generation techniques were in-depth interviews, focus group discussions and observation. Data were analysed thematically. Key findings indicate that communities’ perceived public health communication as having empowered communities in understanding the pandemic preventive and control measures; however, they did not trust the public health agencies due to communication gaps on testing, isolation and treatment. This influenced how they implemented the risk messages. The study concludes that for effective communication to yield the desired behaviour and attitude changes expected by the ministry on covid-19, there was a need to adopt a more behavioural and social communication framework that resonates with people's values, beliefs, priorities, resources and social, cultural and material circumstances. This paper recommends the use of participatory communication media in risk communication such as dialogue, alongside the top-down communication inform of directives with a focus on communication for behavioural impact.

Field Efficacy of Larvivorous Fish and Pyriproxyfen Combined with Community Engagement on Dengue Vectors in Cambodia: A Randomized Controlled Trial.

ABSTRACT.Evidence on the effectiveness of low-cost, sustainable biological vector control tools for Aedes mosquitoes is limited. Therefore, the purpose of this trial was to estimate the impact of guppy fish in combination with the larvicide pyriproxyfen (PPF) (Sumilarv® 2MR) and communication for behavioral impact (COMBI) activities to reduce entomological indices in Cambodia. In this cluster randomized, controlled superiority trial, 30 clusters comprised of one or more villages each was allocated in a 1:1:1 ratio to receive either 1) all three interventions (guppies, PPF, and COMBI), 2) two interventions (guppies and COMBI), or 3) control (standard vector control). Entomological surveys among 40 randomly selected households per cluster were carried out quarterly. The primary outcome was the population abundance of adult female Aedes mosquitoes trapped using adult resting collections. In the primary analysis, adult female Aedes abundance and mosquito infection rates was aggregated over follow-up time points to give a single rate per cluster. These data were analyzed by negative binomial regression, yielding abundance ratios (ARs). The number of Aedes females was reduced roughly by half compared with the control in both the guppy, PPF, and COMBI arm (AR = 0.54; 95% CI, 0.34–0.85; P = 0.0073); and the guppy and COMBI arm (AR = 0.49; 95% CI, 0.31–0.77; P = 0.0021). The effectiveness demonstrated and extremely low cost of including fish rearing in community-based health structures suggest they should be considered as a vector control tool as long as the benefits outweigh any potential environmental concerns. Sumilarv® 2MR was also highly accepted and preferred over current vector control tools used in Cambodia.

Estrategias de comunicación para impactar conductas (COMBI) en enfermedades vectoriales en América Latina

Introducción: Las enfermedades transmitidas por vectores -ETV- están determinadas por una compleja dinámica de factores medioambientales y sociales, estrategias de control han encaminado históricamente conocimiento biológico sobre el vector. Experiencias mundiales muestran que el cambio del comportamiento de las personas es crucial para la prevención de estas enfermedades. La OMS, promovió la metodología COMBI (Communication for Behavioural Impact) para la planificación de acciones de comunicación y movilización social.
 Objetivo: Compilar las experiencias de implementación de estrategia COMBI en América Latina para identificar fortalezas, amenazas y oportunidades de mejora de la metodología como herramienta para la mitigación de ETV.
 Materiales y métodos: Revisión teórica tipo monografía, se incluyeron artículos y documentos indexados, documentos técnicos y literatura gris.
 Resultados: La integración de la estrategia COMBI a los planes de salud pública permite la disminución de la frecuencia, magnitud y gravedad de los brotes y epidemias de las ETV en América Latina. Colombia es uno de los países que ha sistematizado las experiencias y los resultados de la implementación de la estrategia COMBI, lo que le permite a la región tener más argumentos para promover la estrategia.
 Conclusiones: El cumplimiento de los objetivos conductuales, la integración de equipos multidisciplinarios, la investigación formativa, la movilización comunitaria y la abogacía son fortalezas que se evidencian en la implementación de la estrategia COMBI en América latina, y la falta de voluntad política y el cambio constante de personal inciden directamente en el éxito de la estrategia en la región.

Knowledge, Attitude, and Practices Regarding Dengue Fever among Pediatric and Adult In-Patients in Metro Manila, Philippines.

Background: Knowledge, attitude, and practice (KAP) of in-patients with dengue fever (DF) through hospital-based surveillance has not been done. This study aimed to assess and compare the KAP, identify its predictors, correlation, and protective factors among pediatric and adult patients with DF and community-based controls to structure proactive community-wide DF prevention and control programs. Methods: This case-control study involved clinically or serologically confirmed patients (pediatrics n = 233; adults n = 17) with DF admitted in three public hospitals and community-based controls in Metro Manila, Philippines. A pretested structured KAP questionnaire was administered to participants to assess their KAP. Results: Pediatric and adult patients had significantly lower mean scores in the practice (p < 0.001) domain compared with the pediatric and adult controls. Being in senior high school, having had days in hospital, and rash were predictors of KAP among pediatric patients. Knowledge and attitude of patients with DF did not correlate with their practices against DF. Use of mosquito-eating fish, screen windows, and dengue vaccine were protective factors against DF. Conclusion: The study highlights the importance of behavioral change for knowledge and attitude to have significant effect to practices against DF. Thus, we recommend two comprehensive health programs, Communication for Behavioral Impact (COMBI) and Health Belief Model (HBM).

Implementation of guppy fish (Poecilia reticulata), and a novel larvicide (Pyriproxyfen) product (Sumilarv 2MR) for dengue control in Cambodia: A qualitative study of acceptability, sustainability and community engagement.

BackgroundIn Cambodia dengue vector control activities are focused on larviciding with temephos and pyrethroid based adulticide sprays to which Aedes have been shown to be increasingly resistant.A cluster randomized trial assessed the impact of using biological control tools (guppy fish, pyriproxyfen (PPF), and Communication for Behavioral Impact (COMBI) activities in combination), which would be used in a value comparison to traditional chemical control tools. Given these new intervention methods, a qualitative assessment was designed in order to represent the quality of understanding, acceptance, and implementation by participants.Methodology/Principal findingsA total of 103 participants in 12 Focus Group Discussions (FGDs) and nine In-Depth Interviews (IDIs) were included in the study. The majority of participants in intervention villages (50 out of 80) preferred guppy fish over other vector control methods due to ease of use and rearing, quick reproduction and propensity to eat larvae. A substantial number of participants (11 out of 40) in intervention villages with PPF favored it due to long-lasting effectiveness, lack of smell and easy maintenance. Participants showed high demand for both interventions and were willing to pay between 100–500 riel (0.03–0.13 USD). Nearly all participants perceived that the interventions resulted in a reduction in Aedes mosquitos (both adults and immatures) and dengue cases. The presence of larvae in the water despite the use of PPF was a source of concern for some participants, although this was overcome in some cases with proper health education through health volunteers. Interpersonal communication through health volunteers was the most favorite method of transmitting prevention messages.Conclusions/SignificanceThe community led COMBI strategy resulted in high acceptance and perceived effectiveness of the interventions in target villages. Health volunteers are an effective and accepted channel of communication to engage communities, disseminate information and promote behavioral change at the household and community level. If shown effective through corresponding entomological surveys, the interventions should be continued and further strengthened to ensure they are accessible, available and affordable.

The Description of Larva Free Index as COMBI (Communication for Behavioral Impact) Dengue Hemorrhagic Fever Prevention Indicator

Dengue hemorrhagic fever (DHF) has a high incidence rate, especially in the tropical and subtropical area. Various efforts have been made as an attempt to empower the community in PSN-dengue program, but has not yet reached the optimal result. COMBI (Communication for Behavioral Impact) is a dynamic team working to formulate and deliver the message, materials, and appropriate communication media for community problems found by way of a mutually agreed settlement of the problem.Quantitative research was done by cross sectional method to check the water storage containers inside the houses of the respondents. The number of the respondents were 990 male (38.1%), 1612 female (61.9%). Three (0.1%) respondents were aged &lt;17 years, 249 (9.6%) were 17-25 years old, 526 (20.2%) were 26-35 years old, 706 (27.1%) were 36-45 years old, 602 (23.1%) were 46-55 years old, 348 (13.4%) were 56-65 years old, 173 (6.7%) were &gt;65 years old. Most dominant level of education and employment statuses were 1107 (42.5%) high school and 858 (32.9%) were housewives. The average numbers of Larva Free Index in Sleman Regency, Bantul Regency and Yogyakarta municipality were - 75.8%; 70.9%; and 77.3% respectively. The average CI in Yogyakarta municipality was 7.05%, Sleman Regency was 9.68%, and Bantul Regency was 20.86%. The average HI in Yogyakarta municipality was 22.7%, Sleman Regency was 24.13%, and Bantul Regency was 29.02%. This study suggested that the LFI, CI and HI were not in accordance with the target of the Ministry of Health.

Determining the efficacy of guppies and pyriproxyfen (Sumilarv\xae 2MR) combined with community engagement on dengue vectors in Cambodia: study protocol for a randomized controlled trial

BackgroundEvidence on the effectiveness of low-cost, sustainable, biological vector-control tools for the Aedes mosquitoes is limited. Therefore, the purpose of this trial is to estimate the impact of guppy fish (guppies), in combination with the use of the larvicide pyriproxyfen (Sumilarv® 2MR), and Communication for Behavioral Impact (COMBI) activities to reduce entomological indices in Cambodia.Methods/designIn this cluster randomized controlled, superiority trial, 30 clusters comprising one or more villages each (with approximately 170 households) will be allocated, in a 1:1:1 ratio, to receive either (1) three interventions (guppies, Sumilarv® 2MR, and COMBI activities), (2) two interventions (guppies and COMBI activities), or (3) control (standard vector control). Households will be invited to participate, and entomology surveys among 40 randomly selected households per cluster will be carried out quarterly. The primary outcome will be the population density of adult female Aedes mosquitoes (i.e., number per house) trapped using adult resting collections. Secondary outcome measures will include the House Index, Container Index, Breteau Index, Pupae Per House, Pupae Per Person, mosquito infection rate, guppy fish coverage, Sumilarv® 2MR coverage, and percentage of respondents with knowledge about Aedes mosquitoes causing dengue. In the primary analysis, adult female Aedes density and mosquito infection rates will be aggregated over follow-up time points to give a single rate per cluster. This will be analyzed by negative binomial regression, yielding density ratios.DiscussionThis trial is expected to provide robust estimates of the intervention effect. A rigorous evaluation of these vector-control interventions is vital to developing an evidence-based dengue control strategy and to help direct government resources.Trial registrationCurrent Controlled Trials, ID: ISRCTN85307778. Registered on 25 October 2015.

Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study.

BackgroundMalaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas.MethodsA randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages.ResultsThe knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72–5.72)], (η2 = 0.64). The average of mothers’ knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages.ConclusionsThese results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1551-8) contains supplementary material, which is available to authorized users.

Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples.

This study evaluated the effectiveness of the Communication for Behavioral Impact (COMBI)–Eat Less Salt intervention conducted in Viet Tri, Vietnam. The behavior change intervention was implemented in four wards and four communes for one year, which included mass media communication, school interventions, community programs, and focus on high‐risk groups. Mean sodium excretion was estimated from spot urine samples using different equations. A subsample provided 24‐hour urine to validate estimates from spot urine. Information about salt‐related knowledge and behaviors was also collected. There were 513 participants at both baseline and follow‐up. Mean sodium excretion estimated from spot urines fell significantly from 8.48 g/d at baseline to 8.05 g/d at follow‐up (P=.001). All spot equations demonstrated a significant reduction in sodium levels; however, the change was smaller than the measured 24‐hour urine. Participants showed improved knowledge and behaviors following the intervention. The COMBI intervention was effective in lowering average population salt intake and improving knowledge and behaviors.

Intervención educativa para el control del dengue en entornos familiares en una comunidad de Colombia

To evaluate the effectiveness of an educational intervention to induce changes in behavior to eliminate breeding places for the dengue vector in families from a community in the Municipality of Sincelejo, Colombia. An educational intervention type was performed before and after, with a group of 54 families selected by convenience sampling. An educational program designed with the results of a knowledge test, a semi-structured interview, observation guide and the main concepts of the Communication for Behavioural Impact (COMBI) toolkit was applied. The impact was measured by proportion changes and the McNemar test. Post-intervention changes were made in the levels of inadequate knowledge about dengue and behavior of the vector from 14.8% to 3.7% (p=0.109), in their inadequate beliefs from 20.4% to 5.6% (p=0.008) and in adequate practices from 24 to 87% (p=0.001). At the end of the process with each of the participant groups, 64.8% were classified in the action stage. There was a reduction of the number of intradomiciliary Aedes breeding places from 92.6% to 35.2% (p=0.001). The intervention lead participants to adhere to the behavior changes that were promoted. It was useful to subdivide the population into those who apply preventive measures and those who only have the intention of making them, because this enables the health personnel to adopt actions according to the characteristics of each group.

“Pinch, Leave an Inch and Roll”: Applying the Communication-for-Behavioural-Impact (COMBI) Approach to the Promotion of Proper Male Condom Use in Jamaica

IntroductionTHE PROMOTION OF CONSISTENT CONDOM has been a longstanding strategy in the response to the HIV and AIDS epidemic. The generic use a condom every time message has been featured in many health communication campaigns promulgating consistent condom use. This article recounts the experience of the Pinch, Leave an Inch and Roll campaign which focused on the specific steps of putting on a male condom properly, and targeted males aged fifteen to twenty-four years. The campaign was planned during 2008 and implemented during 2009-2010 by the National HIV/STI Programme of Jamaica as one strategic communication activity within their overall behaviour change communication which includes a mix of mediated and interpersonal communication-based interventions. Communication for Behavioural Impact (COMBI), a multifaceted approach to communication planning, is used as the framework for understanding the process of creating the Pinch, Leave an Inch and Roll campaign. It must be noted that while the COMBI approach was not purposefully used in the entire planning process of the campaign, it is applied here post-implementation as a way to conduct a structured review of what occurred during the evaluation, design, and execution stages. Of the National HIV/ STI Programme's many campaigns, Pinch, Leave an Inch and Roll was chosen as a good example of communication in action because summative evaluation indicated that it had a relatively high message recall one year after its implementation.1 The campaign also employed many of the tenets of development communication campaign planning.2Background to the National HIV/STI Programme and its condom promotion activitiesThe National HIV/STI Programme of Jamaica was established in 1986 by the Ministry of Health as an extension of the former Sexually Transmitted Disease Control Programme, which was in existence from 1930. The National HIV/STI Programme is responsible for coordinating and leading the implementation of Jamaica's response to HIV and AIDS. In order to fulfil this mandate, the National HIV/STI Programme focuses on four main components: prevention; treatment, care and support; enabling environment and human rights; and monitoring and evaluation.3Within the HIV-prevention component of the National HIV/STI Programme, behaviour-change communication interventions promoting safer sexual behaviour are created to control the transmission of HIV and AIDS among the wider population and, in particular, among the most at-risk populations which include sex workers, men who have sex with men, people living with HIV, out-of-school youth, homeless drug users, and inmates. The prevention efforts aimed at changing risky sexual activities and sustaining safer sexual practices a multisectoral approach. The HIV prevention team within the Ministry of Health collaborates closely with other agencies offering services that are useful to the various targeted populations. In order to ensure that individuals possess the self-efficacy to adopt and maintain relevant behaviours, the HIV prevention team utilises a number of strategies, including community outreach activities and special events which usually include free HIV testing, and distribution of free condoms coupled with condom demonstrations undertaken by the client and guided by the intervention officer. These are supported by national media campaigns which not only provide information but also encourage the practice of appropriate safer-sex behaviours such as consistent condom use.Other strategies of the National HIV/STI Programme's HIV prevention component include the of cultural vehicles such as television shows and party interventions. Through sponsoring of various television and party events, the programme is able to position its efforts in locations which are likely to increase the visibility of key messages and allow for the conduct of condom demonstrations. In 2009, for example, the National HIV/STI Programme sponsored Magnum Kings and Queens of the Dancehall, the popular Jamaican dancehall competition aired weekly on the television station TVJ. …

A campaign of 'communication for behavioural impact' to improve mass drug administrations against lymphatic filariasis: structure, implementation and impact on people's knowledge and treatment coverage

In the mass drug administrations (MDA) that form the principal strategy of the Global Programme to Eliminate Lymphatic Filariasis, treatment coverages of at least 65%-80% will be needed if the programme is to be successful. In the Indian state of Tamil Nadu, where treatment coverages were typically <65%, a comprehensive strategy of advocacy and communication, called the "communication for behavioural impact" (COMBI) campaign, has been developed and implemented, in an attempt to improve treatment coverage. This strategy combined advocacy, aimed at state-, district- and village-level administrations, with communication activities targeted at individual communities. The main aim was to alter the behaviour of many of those included in the rounds of MDA, so that they would be more likely to accept and consume the diethylcarbamazine tablets offered to them. The COMBI campaign had two variants, COMBI(+) and the more intensive COMBI(+ +), each of which has been implemented in six districts. Both the variants included the "personal selling" of treatment, via door-to-door visiting by a total of 113,500 filaria-prevention assistants. These assistants were able to visit 34%-49% of the households in each target community. In the COMBI(+ +) districts, up to 44% and 38% of households received information on lymphatic filariasis and its elimination via television commercials and posters, respectively. Overall, 78% of the villages in the COMBI(+ +) districts and 33% of those in the COMBI(+) districts were considered to have had good exposure to the communication campaign. At the end of this campaign about 30% more people (than pre-campaign) believed that lymphatic filariasis could be eliminated and many of those targeted considered lymphatic filariasis to be a dreadful disease, knew that a particular day had been designated "Filaria Day", and thought that the tablets offered in MDA should be consumed to prevent or eliminate the disease. Apparently as the result of the COMBI campaign, drug consumption increased, from 33% of those living in endemic communities, to 37% in the COMBI(+) districts and to 49% in the COMBI(+ +). Coverages as high as 65%-73% were recorded among those who had had the maximum exposure to the communication campaign. These results indicate that the COMBI campaign favourably changed the perception and behaviour of the people towards the elimination of lymphatic filariasis. The costs of the COMBI(+) and COMBI(+ +) strategies were only U.S.$0.002 and U.S.$0.009 per capita, respectively.

Reinventing mass communication: a World Health Organization tool for behavioral change to control disease.

Most of the WHO's vertical programs, because they were ill-conceived, ill-designed, and defectively implemented, have fallen far short of expectations. These limitations have been doggedly ignored by the WHO, although the authorities in India have now realized that such vertical programs are expensive and not sustainable. Launching of Communication for Behavioral Impact (COMBI) appears to mark a desperate effort to revive their performance. It represents yet another deviation from the mandate given to the WHO. In 1983, the then director general warned against motivational manipulation of people to sell health ideas, but the WHO has now brazenly come forward to look for help from the private sector. COMBI uses the jargon and language of the market place to "market" health programs; it calls this "cause-related marketing." The WHO has been most a historical in conceptualizing COMBI, as it has not learned from the failure of UNICEF's earlier venture to market child survival by employing experts in social marketing to bring about "community mobilization." The WHO should have reviewed the large body of literature on work in the health social sciences, health education, and the many programs based on the concept of "information, education, and communication." The pointed neglect of such key issues raises serious moral, ethical, and human rights questions. The COMBI approach amounts to be a breach of trust--a threat to human dignity.