WFP 0000102103

Social and Behaviour Change
Communication (SBCC)
Guidance Manual for WFP Nutrition
1 |Guidance Manual for WFPJanuary 2019

Nutrition
For more information contact:
World Food Programme
Nutrition Division (OSN)
Via Cesare Giulio Viola, 68
[email protected]
wfp.org/nutrition
January 2019
2 |Guidance Manual for WFP Nutrition

Contents
Preface ................................................................................................................................................. 5
Acknowledgements ............................................................................................................................ 6
Acronyms ............................................................................................................................................. 7
Tables and Figures .............................................................................................................................. 8
Chapter 1. What is SBCC? ................................................................................................................. 10

Introduction to SBCC ................................................................................... 10
Why is SBCC relevant for nutrition programmes? ................................................ 11
Does SBCC work to improve nutrition behaviours? .............................................. 12
What are some of the key aspects of effective SBCC? ........................................... 12
References ................................................................................................ 14
Chapter 2. SBCC Terminology .......................................................................................................... 15

Overview .................................................................................................. 16
Commonly-used Terminology ........................................................................ 16
One-way Health Communications ................................................................... 16
Two-way Health Communications ................................................................... 17
References ................................................................................................ 22
Chapter 3. Theoretical Basis of Changing Nutrition Behaviours ................................................. 23

Ease of changing nutrition-related behaviours ................................................... 24
Socio-Ecological Model (SEM) ......................................................................... 24
Barriers and Facilitating Factors of Behaviour Change .......................................... 26
References ................................................................................................ 28
Chapter 4. SBCC in WFP Contexts.................................................................................................... 29

Overview .................................................................................................. 29
SBCC Entry Points ....................................................................................... 29
Specific SBCC Entry Points in WFP Nutrition ....................................................... 30
SBCC in Varied WFP Contexts ......................................................................... 33
Chapter 5. Formative Phase ............................................................................................................ 35

Overview – Formative Phase .......................................................................... 36

Step 1. Conduct formative work to gather context-specific information ........................... 37
Step 2. Develop SBCC strategy with well-defined SMART objectives ................................ 44
Appendix 1. Worksheet for outlining determinants of key behaviours ...................... 51
Appendix 2. Template for organizing desk review findings .................................... 54
Appendix 3. Checklist for developing SMART indicators ........................................ 55
Chapter 6. Development Phase ....................................................................................................... 56

Overview - Development Phase ...................................................................... 57
Step 3. Draft creative briefs from formative findings to develop SBCC materials ................ 58
Step 4. Pre-test SBCC materials among target audience segments ................................. 67
Quality Standards - Development Phase ........................................................... 70
References ................................................................................................ 71
Appendix 4. Creative brief template – example used to create a banner ................... 72
Appendix 5. Audience Profile worksheet ........................................................... 73
Appendix 6. Planning matrix for assessing communication channels ....................... 74
Appendix 7. Examples of tailored messages after formative work- integrated stunting
programme ............................................................................................... 75
Appendix 8. Semi-structured interview guide – pre-testing messages ....................... 76
Appendix 9. Focus group discussion guide – pre-testing messages .......................... 78
Appendix 10. Sampling considerations during pre-testing of SBCC materials ............. 80
Chapter 7. Programming Phase ...................................................................................................... 82

Overview – Programming Phase ..................................................................... 83
Step 5. Train staff for effective implementation of SBCC campaign ................................. 84
Step 6. Implement SBCC Campaign within WFP Programme with Partners ....................... 90
Quality Standards - Programming Phase ........................................................... 96
References ................................................................................................ 97
Chapter 8. Monitoring Phase ........................................................................................................... 98

Overview – Monitoring Phase ......................................................................... 99
Step 7. Monitoring the SBCC campaign to identify areas for improvement ..................... 100
Step 8. Improve SBCC strategy based on monitoring efforts ....................................... 108
Quality Standards - Monitoring Phase .............................................................111
References ...............................................................................................112
Chapter 9. Standards of SBCC Programming ............................................................................... 113

Overview – Quality Standards .......................................................................114
SBCC Quality Standards ...............................................................................114

Preface
This guidance manual was developed for use by WFP nutrition staff who aim to improve nutrition
outcomes by complementing nutrition activities with social and behavioural change. A review of
WFP Country Strategic Plans in 2017 revealed widespread strategic planning for social and
behaviour change activities among most WFP-supported countries. With recognition of the high
demand from WFP country offices for these activities, WFP Nutrition has begun prioritizing social
and behaviour change communications (SBCC) as one viable approach – albeit not the only one - to
changing nutrition-related behaviours within the programmes that WFP supports.
Developing detailed, yet useable SBCC guidance that can be adapted to the variety of programmes
where WFP works was no easy task. This guidance manual was created using several different
resources, including the scientific literature, global SBCC guidance resources, and direct inputs from
WFP nutrition staff- including those who attended SBCC capacity-strengthening workshops. In the
coming years, as global SBCC evidence grows and field-level SBCC experiences increase among WFP
country offices, this manual should be updated to reflect the needs of WFP staff and programmes.
This guidance manual introduces a systematic approach to developing culturally-appropriate SBCC

activities. However, changing social norms and improving nutrition-related behaviours in any
setting, especially in those that are resource-constrained, is not without challenges. WFP country
offices should not hesitate to reach out to Regional Bureaux and headquarters as they work
through the steps outlined in the SBCC development process. Sound SBCC design is an art and a
science that benefits from multiple perspectives and diverse inputs.
As WFP country offices use this manual following the suggested SBCC-development approach, there
will inevitably be lessons learned, including both challenges and opportunities, that should be
shared back with the WFP Nutrition Division (OSN) for improving this guidance to best suit the
needs of WFP Nutrition programmes. We hope that you find this guidance manual to be both a
user-friendly and useful tool which allows you to more effectively improve nutrition-related
behaviours across WFP programmes. Additional resources, including an E-learning module on
SBCC, are available on WFP Go. Please do not hesitate to reach out to OSN for SBCC support as you
design, develop, implement, and monitor SBCC activities for improving health and nutrition
worldwide.

Acknowledgements
This SBCC guidance manual was developed by the WFP Nutrition Division (OSN) under the direction
of Lauren Landis. Thank you especially to the OSN Nutrition-specific team for providing technical
inputs during the writing process, including Nancy J. Aburto, Noemi Renzetti, Craig Arnold, Siti
Halati, Dora Panagides, Arghanoon Farhikhtah, Jackson Masonmackay, Vanessa Jones, Alexandria
Schmall, and Stephen Kodish.
In addition, we are very grateful for the support of Eva Monterrosa and Klaus Kraemer (Sight & Life)
who have collaborated with OSN for several years supporting SBCC-related activities, including the
development of this manual. Finally, a big thank you to colleagues in WFP Regional Bureaux and
country offices, especially SBCC specialists Marianela Gonzalez (RBP) and Noor Aboobacker (RBB),
whose field-level feedback was critical for improving upon the interim SBCC guidance manual.

Acronyms
BCC Behaviour Change Communication
BSFP Blanket Supplementary Feeding Programmes
CBT Cash-Based Transfers
CMAM Community Management of Acute Malnutrition
CP Cooperating Partner
IEC Information, Education and Communication
IYCF Infant and Young Child Feeding
LNS Lipid-based Nutrient Supplement
LMICs Low- and Middle-Income Countries
M&E Monitoring and Evaluation
MNP Micronutrient Powders
NGO Non-Governmental Organization
OSN Operation Services Nutrition
PHM Persuasive Health Messages
PIP Programme Impact Pathway
PLHIV/TB People Living with HIV/AIDS and/or Tuberculosis
RAP Rapid Assessment Procedures
RUTF Ready-to-use Therapeutic Food
SBCC Social and Behaviour Change Communication
SDG Sustainable Development Goal
SEM Socio-Ecological Model
SOP Standard Operating Procedures
TSFP Targeted Supplementary Feeding Programmes
WASH Water Sanitation and Hygiene
WFP World Food Programme

Tables and Figures
Tables
Table 1. Commonly-used SBCC approaches and activities ....................................................... 11
Table 2. Key SBCC terms and their descriptions ......................................................................... 13
Table 3. Examples of SBCC Entry Points in WFP Nutrition Programming ............................... 40
Table 4. Examples of formative research data collection methods ......................................... 45
Table 5. SMART behavioural objectives ........................................................................................ 45
Table 6. Planning table with simple checklist for developing SMART SBCC objectives s ...... 59
Table 7. Domains to include in a creative brief to inform SBCC material ............................... 60
Table 8. Considerations of SBCC channels and their level of influence .................................. 62
Table 9. Context-specific considerations when deciding upon appropriate channels ......... 86
Table 10. Example of key categories to include in a training planning matrix ....................... 87
Table 11. Training planning matrix example – interpersonal communication training........ 88
Table 12. Example of a simplified calendar with trainings by SBCC activity ........................... 94
Table 13. Example of mobilization actions prior to and during the harvest season in a
prevention of stunting prevention programme in Malawi (Kodish, 2013)........... 101
Table 14. SBCC-related programme implementation indicators ........................................... 102
Table 15. SBCC-related psychosocial indicators ....................................................................... 103
Table 16. Methods for evaluating nutrition behaviours .......................................................... 106
Table 17. Type of quantitative survey questions and their description……………………………107

Figures
Figure 1. Representation of social marketing and descriptions of “4 Ps” ............................... 19
Figure 2. Multiple levels of influence on nutrition behaviours ................................................. 24
Figure 3. WFP Nutrition Policy: focus areas where SBCC may improve nutrition .................. 30
Figure 4. SBCC development process ........................................................................................... 34
Figure 5. SBCC development process, Formative Phase ........................................................... 36
Figure 6. Core components of SBCC formative work ................................................................. 37
Figure 7. Examples of topics that formative research may help generate for SBCC ............. 39
Figure 8. Examples of Rapid Assessment Procedures manuals in public health ................... 39
Figure 9. Example of planned SBCC activities and points of contact to key influencers in a
WFP-supported stunting prevention programme in Malawi ................................... 42
Figure 10. SBCC development process, Development Phase ................................................... 57
Figure 11. Persuasive Health Message framework for tailoring SBCC messages .................. 63
Figure 12. SBCC development process, Programming Phase .................................................. 83
Figure 13. Example of PIP from a nutrition counselling intervention in Bangladesh ............ 91
Figure 14. Example of GANTT chart for planning SBCC activities............................................. 91
Figure 15. Implementation structure where SBCC activities were implemented in Malawi 93
Figure 16. SBCC development process, Monitoring Phase ...................................................... 99

Chapter 1. What is SBCC?
Purpose:
The purpose of this chapter is to provide an overview of SBCC and describe its importance
for WFP nutrition programmes. This chapter also introduces key SBCC terms that will be used
throughout the remainder of the guidance manual.
Learning Objectives:
After reading this chapter, WFP staff should be able to:
• Explain the differences between several SBCC approaches

• List the types of activities typically found within each SBCC approach
• Understand how and why SBCC is relevant for WFP nutrition programmes
• List key aspects of effective SBCC programming for nutrition
Introduction to SBCC
Social and behaviour change communication (SBCC), is a collection of communications

approaches, activities, and tools used to positively influence behaviours. It is an evidence-based
strategy to help improve health and nutrition outcomes (Lamstein, et al., 2014; Manoff Group,
n.d.). When well implemented, SBCC is an important component in interventions where
behaviour change is needed for improving nutrition. SBCC activities are numerous, yet typically
characterized into three broad categories: interpersonal, media, and community mobilization
(Table 1).

Photo 1: Group nutrition education session with school-aged children
Table 1. Commonly-used SBCC approaches and activities
SBCC Approaches Types of Activities Specific Examples
• Counselling  One-on-one with PLHIV/TB

Interpersonal • Education  Group education in schools
• Support groups  Care groups
• Mass media  National TV programmes

• Mid-sized media  Community radio, billboards
• Small print media  Posters, flyers, stickers
Media • Traditional media  Songs, theatre
• Social media  Twitter, Facebook, Instagram
• Mobile technology  Mobile calls, SMS
 Child Health Days

Community • Campaigns
 Nutrition Days
Mobilization • Issue groups
 Ebola survivors’ group
*Not an exhaustive list of activities/examples; **Table content adapted from Lamstein, et al. (2014).
To motivate behaviour change, SBCC approaches often aim to pass knowledge and evoke
emotions at the individual and household levels, as well as positively change social attitudes,
norms and mobilize entire communities. This combination of efforts, acknowledging multiple
levels of influence on an individual’s behaviours – incorporating a socio-ecological view – make
SBCC well suited to improve nutrition (McLeroy, et al., 1988).
Why is SBCC relevant for nutrition programmes?

Improving nutrition nearly always requires some level of behaviour change. SBCC may help with
the modification of current behaviours, such as nudging a person to make more nutritious food
choices at the market or to adopt improved infant and young child feeding (IYCF) practices. It
may also be used to promote the adoption of new behaviours, for instance, supporting a
household to add micronutrient powders to complementary foods during home fortification.
SBCC is not only about beneficiary behaviours
Nutrition programmes may also aim to change the behaviours of front-line workers who help
deliver programme services. For example, SBCC may be used with the community health workers
conveying breastfeeding messages, as well as beneficiaries who receive them.
Does SBCC work to improve nutrition behaviours?
Although human behaviour is complex and highly contextual, evidence-based SBCC can
effectively improve nutrition. A systematic review of 91 studies from low- and middle-income
countries (LMICs) found that SBCC improved dietary practices among pregnant and lactating
women, enhanced breastfeeding practices, and positively influenced a wide range of
complementary feeding practices (Lamstein, et al., 2014).
SBCC may also increase beneficiary knowledge of nutrition to be sustained for years after an
intervention ends (Hoddinott, et al., 2017a). There is also a positive spill over effect from SBCC:
improved nutrition knowledge and behaviours among the neighbours of beneficiary households
may also be observed (Hoddinot, et al., 2017b). Given the evidence and potential for impact,
SBCC is now globally recognized as one of the essential actions to improve nutrition.
What are some of the key aspects of effective SBCC?
There are specific SBCC characteristics that increase the likelihood of yielding positive nutrition
outcomes.
First, evidence suggests that using multiple SBCC approaches together, is important.
For instance, using both interpersonal (e.g. Care Groups and counselling) and media (e.g.
community radio and social media) approaches is more effective than using either
approach alone (Lamstein, et al., 2014).
Second, SBCC is stronger when it is context-specific, using a combination of specific

communications activities and channels designed to resonate with audience segments
(e.g. adolescent girls, primary caregivers, husbands) and appeal to their core cultural
values (Kreuter, et al., 2003) (Table 2). To understand the activities, channels, and
messages that are most appropriate for a given socio-cultural context, implementers
should conduct formative research, a critical step of SBCC design (Sanghvi, et al., 2013).

Third, SBCC is more effective when targeted messages reach intended audience
segments more frequently – as more exposure is more likely to lead to behaviour
change (Lamstein, et al., 2014).
Table 2. Key SBCC terms and their descriptions
SBCC Terms Description
Audience Sub-groups of a population whose members have similar underlying

Segments behavioural characteristics (Slater, 1996). Identifying audience segments
as part of SBCC is critical for selecting appropriate media, channels, and
messages that are interesting, informative, and resonate with individuals.
Formative Descriptive, participatory mixed-methods research conducted before

Research a programme to inform its design and implementation. Conducting
formative research in SBCC is a critical step for understanding the socio-
cultural context, identifying audience segments, and developing targeted
channels and messages. Formative research helps ensure a programme is
culturally appropriate and thus more effective (Kreuter, et al., 2003).
Targeted Messages that are developed for a specific audience segment (Noar,
Messages Benac and Harris, 2007). For example, a nutrition programme may use
targeted messages to appeal to adolescent girls: an audience segment with
particular behavioural motivators, attitudes, and knowledge. How an SBCC
programme appeals to adolescent girls will differ from how it targets male
community leaders.
There are many entry points for SBCC in WFP nutrition programmes and numerous resources
available globally (HC3, 2017). While a multi-step, systematic development process is suggested
for effective SBCC, each WFP nutrition programme is unique and may require a tailored
approach.

References
Health Communication Capacity Collaborative [HC3]. (2017). Catalog of Project Tools and
Resources for Social and Behavior Change Communications. Available at
https://healthcommcapacity.org/wp-content/uploads/2014/02/HC3-Catalog_10MB.pdf
Hoddinott, J., et al. (2017a). Nutrition behaviour change communication causes sustained
effects on IYCN knowledge in two cluster-randomized trials in Bangladesh. Maternal & Child
Nutrition.
Hoddinott, J., et al. (2017b). Behaviour change communication activities improve infant and
young child nutrition knowledge and practice of neighbouring non-participants in a cluster-
randomized trial in rural Bangladesh. PLOS ONE. 12(6): 13.
Kreuter, M.W., et al. (2013). Achieving cultural appropriateness in health promotion programs:
targeted and tailored approaches. Health Education & Behaviour. 30(2): 14.
Lamstein, S., et al. 2014. Evidence of effective approaches to social and behaviour change
communication for preventing and reducing stunting and anaemia: report from a systematic review.
USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally. SPRING
Project: Arlington, VA.
Manoff Group. (n.d). Defining Social and Behaviour Change Communication (SBCC) and other
essential health communication terms: Technical Brief. The Manoff Group: Washington, D.C.
McLeroy, K.R., et al. (1988). An ecological perspective on health promotion programs. Health
Education Quarterly. 15(4): 7.
Noar, S.M., Benac, C.N., & Harris, M.S. (2007). Does tailoring matter? Meta-analytic review of
tailored print health behaviour change interventions. Psychological Bulletin. 133(4): 21.
Sanghvi, T., et al. (2013). Tailoring communication strategies to improve infant and young child
feeding practices in different country contexts. Food and Nutrition Bulletin. 34(2): 12.
Slater, M.D. (1996). Theory and method in health audience segmentation. Journal of health
communication.1:17.

Chapter 2. SBCC Terminology
Purpose:
The purpose of this chapter is to explain behaviour change terms, including SBCC, that are
commonly used in public health. It seeks to clarify the unique nature of SBCC vis-à-vis the
various communications-based approaches commonly employed across health domains.
• Understand how SBCC evolved from previously-used strategies for changing health
behaviour
• Distinguish between various behaviour change terms commonly used in public health
• Enable WFP staff to thoughtfully consider and choose appropriate behaviour change
communications strategies considering the type of WFP nutrition intervention being
implemented
Photo 2: One-on-one nutrition counselling in a health clinic

Overview
Many health communication terms exist and are often used interchangeably, sometimes
incorrectly (Fox, 2012). There is continual debate, even among experts, about the varied
terminology used within health promotion which, like all fields, is in constant evolution. The
explanations below seek to clarify the terms most commonly used in public health when
referring to different forms of health communication. Note that while these terms are similar in
definition, they in fact have subtle differences that make it challenging to use them consistently
in discussions with partners and in writing. There is potential for misunderstandings if terms are
not used correctly and consistently. It is helpful to clarify exactly what a term means for WFP
Nutrition before using it to pitch an idea, align with partners, or design a programme.
Commonly-used Terminology
One-way Health Communications
While most communication approaches offer chances for community members to interact with
programme implementers, some approaches that tend to facilitate a one-way flow of
information from nutrition programmers to community members. Two such approaches are
described below.
Nutrition Education
Objective: Nutrition education aims to facilitate knowledge sharing and informed decision-
making through student-teacher interactions on relevant topics (Contento, 2013).
Description: Nutrition education is a health communications term used in settings where

individuals – typically students in school settings, for WFP purposes – receive information based
on a standardized curriculum. This type of education is usually delivered in classrooms among
primary- or secondary-school students. However, it can also be delivered in clinical settings
where groups of individuals may gather after receiving care, such as at therapeutic feeding
centres in the management of acute malnutrition.
Relevance to WFP: While nutrition education may include a combination of methods designed to
help individuals improve their knowledge and change their attitudes toward healthy diets, in
many settings where WFP works, nutrition education includes didactic instruction presenting
nutrition facts. However, this type of model need not be the norm: innovative approaches in
nutrition education that allow for hands-on learning and skills building are possible but require
both dynamic curricula and skilled teachers to facilitate such opportunities. School feeding may
offer one viable platform from which nutrition education may be incorporated in settings where
WFP operates (UNSCN, 2017; WFP, 2017).

Information, Education and Communication (IEC)
Objective: IEC uses a wide range of channels and materials to pass knowledge and instructional
messages to individuals, with the goal of facilitating informed decision-making around health
and nutrition.
Description: Developed decades ago, IEC was one of the first approaches aiming to improve
health and nutrition behaviours. It is based on the premise that solely providing people with an
informed base for making choices will result in positive behaviour changes. Although the
objective of IEC may seem reasonable, it incorrectly assumes most people will follow health and
nutrition advice when they are provided with the “correct” biomedical information from
“experts.”
Relevance to WFP: Evidence around IEC

Information is not enough
suggests that while it can help to improve
knowledge and attitudes, largely it has been Consider your own behaviour: even though
ineffective in positive behaviour change or you know fresh vegetables are healthy to eat,
do you always eat them?
improvements in health outcomes (Fox,
2012). Using IEC to pass one-way messaging
to community members may be appropriate in WFP programmes where only programme-
related information is relevant and necessary for participation, such as facts about eligibility
criteria, programme duration, or food distribution times.
Two-way Health Communications
Within health communications, there are various approaches designed to influence behaviours
through interactions between community members and programme implementers. These
approaches enable interpersonal discussions, problem solving, and questions/answers. Several
examples are described below.
Nutrition Counselling
Objective: Counselling sessions are typically designed for nutrition staff to pass standard
messages to beneficiaries while offering various, tailored choices and strategies for beneficiaries
to adopt, to best improve their own health and nutritional status (Ashworth and Ferguson, 2009).
Description: Nutrition counselling involves a one-on-one exchange between a health provider

and a beneficiary. As nutrition counselling is interactive and intimate, sessions often involve an
assessment of an individual’s current dietary practices before offering tailored counselling for
dietary improvement. The content of counselling sessions varies by type of WFP programme,
and may focus on a range of health and nutrition issues, including: discussion about dietary
recommendations, child growth monitoring, IYCF practices, appropriate utilization of food
assistance, and community-based rehabilitation.

Relevance to WFP: WFP programmes utilize nutrition counselling in management of moderate
acute malnutrition (MAM) programming as well as in clinical settings where people living with
HIV/AIDS and/or Tuberculosis are beneficiaries (PLHIV/TB). Individual-based counselling guidance
is usually delivered through job aides like these examples used in Nigeria (FANTA Project, 2017).
Social Marketing
Objective: Drawn from the private sector’s experience with sales and marketing, social marketing
was developed to motivate people to adopt particular products, services, or behaviours for
improving health.
Description: Social marketing is an approach used to positively influence the acceptability of

social ideas with consideration of product planning, pricing, communication, distribution and
marketing research (Kotler and Zaltman, 1971). Social marketing focuses on voluntary behaviour
change and aims to improve welfare and society with clear benefits for the beneficiary
(MacFadyen, Stead, and Hastings, 2003; Houston and Gassenheimer, 1987). It applies marketing
techniques, such as audience segmentation and targeted messages, to ensure beneficiary
insights are considered during programming (Andreasen, 1995; Kotler, et al., 1996; Lefebvre and
Flora, 1988).
This framework involves strategic planning; formative research with audiences and channel
analysis; and tailoring of communication strategies according to the needs and desires of the
audiences considering: product, price, place, and promotion – called the “4 Ps” of social
marketing.

Figure 1. Representation of social marketing and descriptions of “4 Ps” *Adapted from Population
Services International Delta Companion Tool (PSI, 2015)
Relevance to WFP: Social marketing is an approach that is often applied to nutrition programmes
where products – specialized nutritious foods – are provided as part of food assistance. Using a
social marketing approach for a WFP nutrition programme that provides micronutrient powder
for pregnant and lactating women, for instance, may make sense. However, the social marketing
approach may not be most effective for integrated nutrition programmes where non-product
related behaviours, such as optimal IYCF practices, are also being promoted.
Behaviour Change Communication (BCC)
Objective: BCC is the application of interactive, theory-based communication aimed to change

individual-level practices (Briscoe and Aboud, 2012).
Description: BCC is well suited to address more Behaviour

complex nutrition practices, which require
Single action, such as “exclusive
changes in several behaviours to achieve positive breastfeeding from 0 – 6 months”
outcomes. Consider IYCF practices, for instance,
Practices
where a set of behaviours including breastfeeding
and complementary feeding practices, may need A set of habitual behaviours, such as “IYCF
practices,” which include several individual
to be changed to improve young child nutrition.
breastfeeding and complementary
feeding behaviours in combination.
BCC often leverages written or visual
communication (e.g. pamphlets, job aides,
posters) as the primary communication medium for delivering both instructional and

motivational messages intended to resonate with individuals. It may also utilize mass media
approaches to reach communities. However, BCC tends to focus on individual-level behaviour
change and draws largely from individual-level behaviour change theories.
Similar to social marketing, BCC also uses formative

BCC versus IEC research to understand the many determinants of
The messages used in BCC are beneficiary behaviours. This research often reveals
typically both motivational and factors related to the attitudes and knowledge of
instructional, a key difference from
specific audience segments, as well as other factors
IEC, nutrition education, and
counselling which tend to be only that make it easy or difficult for a person to carry out
instructional and fact-based. behaviours. For instance, formative work may reveal
that people have the knowledge about optimal IYCF but
may not be able to provide nutrient-dense, complementary foods throughout the year due to
seasonal food insecurity.
Relevance to WFP: BCC may be incorporated into WFP nutrition programmes where individual-
level behaviour change is the primary focus. In most cases, though, SBCC may be more
appropriate considering the integrated nature of WFP nutrition programmes.
Social and Behaviour Change Communication (SBCC)
Objective: SBCC approaches take a socio-ecological view, aiming to impart knowledge or evoke
emotions at the individual and household levels, as well as change social attitudes and mobilize
entire communities to improve health and nutrition practices (Fox, 2012).
Description: SBCC draws from the understanding that

“Knowledge is necessary, but
knowledge is necessary, but not sufficient for nutrition-related
not sufficient for nutrition-
behaviour change (Worsley, 2002). Thus, SBCC is an extension related behaviour change…”
of previous approaches, including BCC, as SBCC acknowledges
the underlying multi-level social and contextual dimensions of behaviour. As a result, SBCC
offers a more robust set of approaches for mobilizing targeted populations for change.
In addition to the interpersonal and media approaches used in BCC, social and community
mobilization is a key component of SBCC where creating an enabling environment for behaviour
change is a primary focus. Social mobilization is a process that consists of community-level
sensitization and mobilization activities that aim to ensure multiple levels of influence on
behavioural outcomes (HC3, 2016).
Relevance to WFP: For WFP Nutrition, SBCC should be a core programme approach delivered in
conjunction with other multiple programme activities. SBCC can achieve change on its own but
should be delivered as part of a more comprehensive nutrition approach (e.g. SBCC + Cash-

based Transfers (CBT), SBCC + CMAM). Examples of SBCC for WFP Nutrition are presented in
more detail in Chapter 4 of this guidance.
Refer to this technical brief for more information about these various behaviour change
communication terms (Fox, 2012).

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World Food Programme [WFP]. (2017). How school meals contribute to the Sustainable
Development Goals: a collection of evidence. Available at
http://docustore.wfp.org/stellent/groups/public/documents/resources/wfp290540.pdf

Chapter 3. Theoretical Basis of Changing
Nutrition Behaviours
Purpose:
The purpose of this chapter is to highlight the utility of using health behaviour change
theoretical frameworks when designing, implementing, and monitoring SBCC programmes.
This chapter also explains describes the Socioecological Model, the guiding behaviour change
framework that serves as the foundation for designing and implementing WFP programmes
where SBCC is a core activity.
• Acknowledge the complex, multi-level determinants of nutrition behaviours

• Distinguish among behavioural determinants at each level of the Socio-Ecological Model
(SEM)
• Outline potential barriers and facilitating factors to nutrition behaviours at all SEM
levels
• Understand how WFP nutrition programs can work at multiple levels of the SEM
Photo 3: Changing the dietary behaviours of young children often requires changing the
behaviours of primary caregivers and other household members

Ease of changing nutrition-related behaviours
Changing nutrition-related behaviours, which are steeped in longstanding family traditions and
deep-rooted, socio-cultural norms, can be challenging (Aboud and Singla, 2012; Fischler, 1988).
The scientific literature is filled with evidence of both successful and failed attempts to change
behaviours to improve nutrition outcomes. No ‘silver bullet’ exists when it comes to effective
health or nutrition-related behaviour change.
One constant, though, is the recognition that theories of behaviour change are important for
successful programme design and implementation (Ganz and Bishop, 2010). Theoretical models
are important frameworks for understanding human behaviours, and thus are very useful for
developing nutrition programmes where behaviour change is needed.
Socio-Ecological Model (SEM)
While many behavioural theories exist across public health, the SEM is the primary model
guiding SBCC programming. In most cases, nutrition-related behaviour is not only a personal
choice but also the product of the environment in which people live (McLeroy, et al, 1988). The
SEM acknowledges that nutrition behaviours are influenced by factors at various different levels
of influence (Figure 2).
Figure 2. Multiple levels of influence on nutrition behaviours
Policy
Environment Global nutrition guidelines, national and
sub-national policies, funding, etc.
Community
Core cultural values, religion, kinship
Characteristics
structure, geographic location, livelihoods, etc.
Organizational Factors Distance to nutrition clinic, health service

costs, school education, quality of care, etc.
Interpersonal Influences Social influences from friends, peers, co-

workers, neighbours, community leaders, etc.
Individual Characteristics Knowledge, self-efficacy, attitudes, age,

gender, ethnicity, education, health status, etc.
Nutrition
Behaviours

Individual Characteristics
Risk perception
At the individual level, many factors influence
The extent an individual perceives an
illness to be a threat, including nutrition behaviours. A person’s knowledge,
perceived severity and susceptibility to attitudes, risk perception, and self-efficacy are
it.
important predictors of their intention to carry out
Self-efficacy those behaviours (Ajzen and Fishbein, 1972;
A person’s confidence in their ability to Schwarzer, 2008). Further, a person’s age, gender,
successfully carry out a behaviour. ethnicity, individual income level, level of education,
and physiological status may also determine
nutrition behaviours. High-quality SBCC recognizes that a person’s knowledge and attitudes are
necessary, but not sufficient, for behaviour change – even though someone knows the benefits of a
behaviour does not mean they will practice it (Worsley, 2002).
Interpersonal Influences
Social influences also play an important role in shaping individual nutrition behaviours,
particularly during adolescence (Story et al., 2002). The social influence of friends and immediate
family members affects how people behave. This influence extends to other household
members including in-laws and grandparents, as well as community members such as village
heads and religious leaders. Interpersonal influences both directly and indirectly play a role in
nutrition behaviours.
Photo 4: Dietary behaviours of school-aged children are influenced by both interpersonal

(classmates, teachers) and organizational (school) factors

Organizational Factors
Nutrition behaviours occur within a larger system that includes hospitals, health clinics, non-
government organizations and feeding centres, etc. These organizational factors also include
non-health structures such as schools and civil society organizations, where related nutrition
services may be provided.
Many organizational factors influence nutrition behaviours, including access issues, such as far
distances and high health care costs, quality of care provided, and range of services offered.
Organizational factors are an important determinant of nutrition behaviours in communities.
Community Characteristics
The underlying social and cultural context influences most health- and nutrition-related
behaviours, as most dietary practices are steeped in longstanding traditions and cultural
practices that have been passed from one generation to the next. Community characteristics
affecting nutrition behaviours may also include geographic location, religious affiliation, kinship
structure, socio-economic status, and core cultural values (Gittelsohn and Vastine, 2003).
Policy Environment
Policies exist at international, national, and sub-national levels. Policies and guidelines may
influence the level of funding and attention given to any health or nutrition issue. They may also
serve as guidance for nutrition programming at the local level, and thus positively influence
behaviours. To the contrary, a lack of global guidance, or limited level of political will around any
nutrition topic may cause confusion and constrain behaviours at the local level. Often, the policy
environment plays a crucial role in the level of sustainability in nutrition programmes: clear
policies and guidelines help create a positive enabling environment to sustain change (Caraher
and Coveney, 2004).
Barriers and Facilitating Factors of Behaviour Change
Barrier
A determinant of behaviour that makes it harder for people to carry out a behaviour. For example,
traditional household food sharing practices, driven by cultural values, may be a community-level
barrier to the appropriate use of specialized nutritious foods by young children within a household.
Facilitating factor
A determinant of behaviour that makes it easier for people to carry out a behaviour. For instance, a
supportive, encouraging husband may be a facilitating factor at the interpersonal level by making it
easier for mothers to exclusively breastfeed.
Behavioural determinants encompass both barriers and facilitating factors to nutrition

behaviour change (Shepherd et al, 2006). It is very important to identify barriers and facilitating

factors prior to designing and implementing an SBCC strategy. The worksheet in Appendix 1 may
help outline key determinants of nutrition behaviours using the SEM as the SBCC theoretical
framework.
In summary, it is not just an individual’s willpower or knowledge that predicts their nutrition-
related behaviours. Nutrition-related behaviours are determined by a host of multi-level
sociocultural and environmental factors that enable someone to practice (or not) a certain
behaviour. The SEM serves as the framework to guide SBCC design, implementation, and
monitoring efforts. Its application to each of these steps will be explained in subsequent
chapters.

References
Aboud, F. E., & Singla, D. R. (2012). Challenges to changing health behaviours in developing
countries: a critical overview. Social science & medicine, 75(4), 589-594.
Ajzen, I., & Fishbein, M. (1972). Attitudes and normative beliefs as factors influencing behavioral
intentions. Journal of personality and social psychology, 21(1), 1.
Caraher, M., & Coveney, J. (2004). Public health nutrition and food policy. Public health nutrition,
7(5), 591-598.
Fischler, C. (1988). Food, self and identity. Information (International Social Science Council), 27(2),
275-292.
Ganz, K. & Bishop, D.B. (2010). The Role of Behavioural Science Theory in Development and
Implementation of Public Health Interventions Annu. Rev. Public Health. 31:399–418.
Gittelsohn, J., & Vastine, A. E. (2003). Sociocultural and household factors impacting on the
selection, allocation and consumption of animal source foods: current knowledge and
application. The Journal of Nutrition, 133(11), 4036S-4041S.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health
promotion programs. Health education quarterly, 15(4), 351-377.
Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption
and maintenance of health behaviors. Applied Psychology, 57(1), 1-29.
Shepherd, J., Harden, A., Rees, R., Brunton, G., Garcia, J., Oliver, S., & Oakley, A. (2006).
Young people and healthy eating: a systematic review of research on barriers and facilitators.
Health Education Research, 21(2), 239-257.
Story, M., Neumark-Sztainer, D., & French, S. (2002). Individual and environmental influences
on adolescent eating behaviors. Journal of the American Dietetic Association, 102(3), S40-S51.
Worsley, A. (2002). Nutrition knowledge and food consumption: can nutrition knowledge change
food behaviour? Asia Pacific journal of clinical nutrition, 11(s3).

Chapter 4. SBCC in WFP Contexts
Purpose:
The purpose of this chapter is to introduce SBCC as a complementary intervention to improve

nutrition outcomes in alignment with the WFP Nutrition Policy (2017 – 2021). The chapter
provides specific examples of entry points for SBCC activities across WFP nutrition programmes.
However, each WFP nutrition context and country-level programme is unique, and SBCC
activities will thus need to be tailored by context.
• Describe how SBCC activities may complement WFP nutrition programmes
• List key entry points of SBCC across WFP nutrition programmes
• Articulate nutrition-related behaviours in WFP nutrition and non-nutrition programmes
Overview
The overall goal of WFP is to support and enable national governments to meet targets for
Sustainable Development Goals (SDG). WFP Nutrition helps improve both the physical and
economic access to nutritious foods as well as intra-household food access, utilization and food
safety. Often, the most vulnerable members of households may have restricted access to and
poor utilization of nutritious foods.
WFP Nutrition aims to reduce constraints on food

access and ensure that all food provision is Where can SBCC activities improve a
introduced appropriately in the home food nutrition programme?
environment. Target beneficiaries should receive the Anywhere behavioural modification may
appropriate amount and frequency of food to meet improve nutrition can be considered an
entry point for SBCC.
their nutrient requirements. SBCC activities across
nutrition and non-nutrition programmes can help to
ensure that the food and nutrient needs are met by vulnerable populations.
SBCC Entry Points
There are widespread entry points for SBCC across WFP Nutrition and/or in collaboration with
other WFP Programmes. Three primary focus areas (the yellow boxes in Figure 3) of the WFP

Nutrition Policy (2017–2021) will benefit from the application of SBCC approaches, in particular:
1) Increased availability of safe, nutritious foods: SBCC can help increase food availability, for
instance by helping to improve agricultural yields among smallholder farmers. 2) Improved access
to safe, nutritious food: SBCC can improve access through advocacy efforts aimed at ensuring
food assistance is available to vulnerable populations. 3) Increased demand/consumption for safe,
nutritious foods and services: SBCC can help increase demand for nutritious foods through
marketing at point of purchase, and by ensuring equitable household food allocation so
vulnerable household members have the food quantity and quality needed during key life
stages.
Figure 3. WFP Nutrition Policy: Key WFP Entry Points for SBCC to Improve Nutrition
Specific SBCC Entry Points in WFP Nutrition
There are specific SBCC entry points to improve food availability, access, demand, and
consumption:
Nutrition-specific interventions
Community-based Management of Acute Malnutrition (CMAM), which relies on the

empowerment of caregivers in the treatment process, requires intensive SBCC to help manage
child malnutrition by increasing referrals, reducing stigma, improving default rates, lowering risk
of relapse, and widening coverage.
SBCC should also play an important role in ensuring the appropriate utilization of specialized
nutritious foods (e.g. increasing acceptability, reducing intra-household sharing) and uptake of

services (e.g. vitamin A supplementation, deworming) provided as part of Targeted
Supplementary Feeding Programmes (TSFP).
Photo 5: Behaviour change is needed when introducing specialized nutritious foods, which are
novel to most beneficiaries.
Treatment programmes should serve as a platform for

promoting optimal IYCF practices to caregivers – in
alignment with concurrent activities by partner
agencies working in IYCF promotion – as well as
improved dietary behaviours among people living with
HIV and tuberculosis.
SBCC should also be a core part of prevention

programmes that necessitate behaviour change
during the first 1,000 days from conception to a child’s
second birthday. Improving the health and dietary
practices among all household members is important
for improving infant and young child health during
this ‘Window of Opportunity’.
Just as pregnant and lactating women and adolescent

girls are particularly important vulnerable groups to
target, so too are men, boys, and grandparents who
often play important roles in shaping intra-household
dietary behaviours. As such, these audiences should often also be considered when designing
SBCC programmes.
In addition, SBCC can be used to promote improved breastfeeding practices, complementary

feeding practices, WASH practices, and access to care services that often require some level of
behavioural modification. SBCC should not only be used to promote optimal IYCF practices
during the ‘Window of Opportunity’ but also to improve the acceptability and appropriate
utilization of specialized nutritious foods through Blanket Supplementary Feeding Programmes.
Nutrition-sensitive interventions
SBCC is one approach to increase the nutrition sensitivity of various WFP programmes that aim
to integrate complementary interventions across food value chains. However, it is important to
recognize that incorporating SBCC into a WFP programme does not automatically make it
nutrition-sensitive. For more information on increasing the nutrition sensitivity of programmes,
please refer to the Nutrition-Sensitive guidance.

There are many entry points to SBCC in WFP
SBCC should complement WFP nutrition programmes that may not focus directly on
programmes
nutrition. For instance, Cash-Based Transfers
SBCC is essential to address food access (CBT) may help improve access to nutritious
challenges by building demand for, and
foods, but SBCC is an important
improving consumption of, nutritious foods,
which should be incorporated into larger WFP complementary activity to support
nutrition programs households to make nutritious food
purchases in the marketplace, use healthier
food preparation methods at home, and ensure equitable intra-household food allocation. SBCC
may also accompany other programmes, School Feeding programmes, as schools offer a unique
platform to engage school-aged children and adolescents. SBCC, coupled with CBT and School
Feeding, also has the potential to address the double burden of malnutrition within integrated
behaviour change interventions that may use various strategies to improve health and nutrition
outcomes. Additional entry points for SBCC, such as those related to agricultural production and
smallholder farming, also exist and should be considered within WFP nutrition-sensitive
activities.
Nutrition in Emergencies
SBCC is an important aspect of nutrition programming within emergency contexts. For example,
SBCC activities should complement the provision of specialized nutritious foods, which tend to
be novel to beneficiary populations. This means they require careful introduction, using social
mobilization to build community trust, as well as tailored messaging through both media (e.g.
social media) and interpersonal approaches (e.g. Care Groups) for appropriate utilization.
WFP, as a partner and leader in the Global Nutrition Cluster, should ensure that timely and
culturally-appropriate SBCC accompanies WFP operations in emergencies. Adapting the SBCC
development process, outlined in Chapters 5–8 of this manual, for emergency settings should be
done thoughtfully, as resources, capacity, and timelines are often abbreviated in emergency
contexts. Many of the SBCC activities for nutrition-specific programming proposed above would
also apply to nutrition programming in emergencies but may need to be adapted and delivered
differently during implementation.

Table 3. Examples of SBCC Entry Points in WFP Nutrition Programming
WFP Programme Areas Example Entry Point for SBCC
Nutrition-Specific
Engage caregiver support groups and community leaders
CMAM to reduce stigma for acute malnutrition, aim to improve
programme coverage (e.g. improved screening, referrals)
Home-fortification with MNP Community-wide social marketing campaign to increase

demand for MNP among caregivers
Prevention of chronic Community mobilization (e.g. cooking demonstrations) to

undernutrition or stunting increase community acceptance and caregiver utilization of
lipid based nutrient supplements (LNS) among children 6-
23 months old
TSFP Incorporate tailored messaging in nutrition counselling by

health workers to improve acceptance/utilization of SNFs
Nutrition in Emergencies
Infant and Young Child Community support groups for infant and child feeding
Feeding in Emergencies (IYCF- with mothers, scheduled during food distributions
E)
Blanket Supplementary Food SBCC incorporated into general food distribution using
Programmes (BSFP) traditional media (e.g. dance groups) on distribution days
to improve optimal utilization of SNFs
Nutrition-Sensitive
School Feeding SBCC to help improve safety of school feeding through

promoting optimal WASH and food preparation practices
among school cooks
Smallholder Agricultural SBCC to engage farmer groups and support farmers to
Market Support (SAMS) adopt improved farming techniques to increase yields
Cash-based Transfers Complement CBT with SBCC at point of purchase to nudge

people toward nutritious food choices in markets
SBCC in Varied WFP Contexts
Regardless of the type of WFP programme in which you want to incorporate SBCC,
consider how each step of the following phases. Each step represents a key piece along
the SBCC-development process, which will be discussed in more detail throughout
subsequent chapters of this guidance.

Figure 4. SBCC Development Process
• Step 1. Conduct formative work to gather context-specific information

Formative • Step 2. Develop SBCC strategy with well-defined SMART objectives
Phase
• Step 3. Draft creative briefs from formative work to develop SBCC materials
Development
• Step 4. Pre-test SBCC materials among target audience segments
Phase
• Step 5. Train staff for effective implementation of SBCC campaign

Programming
• Step 6. Implement SBCC campaign within WFP programme with partners
Phase
• Step 7. Monitor SBCC campaign to identify areas for improvement

Monitoring
• Step 8. Improve SBCC strategy based on monitoring efforts
Phase
There is no ‘one-size-fits-all’ approach to incorporating SBCC in

Context Matters
WFP programmes. Each WFP nutrition programme has its own
needs based on unique contexts and populations, as well as Remember: SBCC
development process does
available capacity and resources. For nutrition in emergencies,
not have to be entirely linear.
for example, a shortened SBCC development process may be Sometimes multiple steps can
more appropriate based on immediate communications needs be conducted at the same
time or in a different order,
and limited operational time frames typical of emergency
depending on context.
contexts. WFP country offices can often take advantage of desk
reviews and formative research conducted previously in their own context (e.g. Fill the Nutrient
Gap analyses), or in other similar settings, to adjust the process as needed.
WFP Regional Bureaux and OSN are available to provide SBCC technical guidance for adapting
SBCC activities to unique WFP programmes as needed and upon request.

Chapter 5. Formative Phase
Purpose:
The purpose of this chapter is to explain Steps 1 and 2 of the SBCC development process. Step 1
involves conducting formative work to help ensure a context and culturally appropriate SBCC
programme component; and Step 2 includes the development of an SBCC strategy, including
objectives. This chapter discusses how WFP staff may work through these steps to form the basis
of a strong nutrition programme aimed to change behaviours.
• Understand the importance of the formative phase in SBCC programme design
• Describe considerations for conducting formative work, including a desk review, stakeholder
engagement and primary data collection
• Describe SBCC strategy development drawing from formative findings
• Write out SMART behavioural objectives to guide SBCC
Photo 6: Formative work is critical for ensuring development of context-specific and culturally-
appropriate SBCC approaches in the diverse contexts where WFP works

Overview – Formative Phase
The formative phase of SBCC development is an important phase that includes several activities
that will form the basis of an effective SBCC strategy. A new or existing WFP nutrition programme
may have an overarching nutrition goal (e.g. reducing the prevalence of anaemia among
pregnant and lactating women), and the formative phase is important for shaping the SBCC
activities most appropriate for reaching it. The formative phase will allow programme staff to
take stock of the SBCC landscape, garner stakeholder support, and define appropriate SMART
behavioural objectives in light of the barriers and facilitating factors related to the desired
outcomes. Importantly, high-quality formative work includes more than just data gathering
through research.
Figure 5. SBCC Development Process, Formative Phase

• Step 2. Develop SBCC strategy with well-defined SMART objectives
Formative
Phase
• Step 3. Draft SBCC creative materials from formative work

Development
Phase

Programming
Phase

Monitoring
Phase

Step 1. Conduct formative work to gather context-
specific information
Figure 6. Core components of SBCC formative work
Desk Review
The first step for informing an

SBCC strategy is to conduct a
desk review. This activity includes Stakeholder
Engagement
finding, reviewing, and
synthesizing recent, relevant
Primary Data
literature on the health and Desk Review
Collection
nutrition topics of interest, in
addition to understanding the
local context and enabling
SBCC
environment. To be most Strategy
comprehensive and useful, it
should include both grey and
scientific literature.
A desk review will provide insightful information

Grey literature
related to many topics. However, keeping a desk
review efficient and useful means identifying Non-peer-reviewed documents generally
consisting of programme reports and
specific topics of information that will be most
national or sub-national nutrition
useful for informing the SBCC strategy: surveys.
demographics; socio-cultural aspects of Scientific literature
nutrition; health systems; epidemiological data;
Published, peer-reviewed articles found
behavioural insights; and previous SBCC work, in scholarly journals, most often
including relevant case studies and lessons summarizing results of original research.
learned, etc (HC3, 2016).
The desk review should conclude with a compilation of relevant documents offering a
comprehensive picture about what is known and not known with regard to informing the SBCC
strategy. It should also result in a concise synthesis of findings, well organized for sharing with
stakeholders and the formative research team. The worksheet in appendix 2 may be useful for
organizing desk review findings (HC3, 2016).
A desk review is an important activity to avoid duplication of previous programme efforts (if
there were such programmes prior); as well as to identify the key gaps in knowledge about a
particular context or population, to guide the primary research and inform appropriate SBCC
development.

Stakeholder Engagement
An often-overlooked aspect of formative work is stakeholder engagement. How a WFP office

chooses to engage with stakeholders may vary by context but may utilize existing structures
such as National Coordination Committees or other formalized groups that include SBCC
programming. In any context, WFP-supported nutrition programmes are strengthened by early
and consistent involvement of in-country stakeholders, including those from government, non-
government organizations (NGOs), UN agencies, academia, civil society, and community
members.
Stakeholder engagement may take many

Stakeholder Engagement Example
forms at both national and sub-office
Interagency discordance was one contributing
levels. Setting up SBCC technical advisory
factor to programmatic challenges in a
micronutrient supplementation programme that groups offers a way for stakeholders to
included SBCC activities, and should remain a key provide technical inputs throughout the
lesson learned for WFP nutrition (Kodish et al.,
entire development process.
2011).
Hosting SBCC trainings around each phase
of the development process is also an opportunity for Country Capacity Strengthening. Holding
regular multi-stakeholder meetings provides an opportunity for knowledge sharing,
dissemination of programme updates, and better alignment of in-country initiatives. Inviting
partners to partake in specific activities during SBCC design, implementation and monitoring
may further strengthen national capacity, and should be considered throughout each step of
SBCC development. Any of these initiatives require coordination and delegation on behalf of the
WFP Nutrition team, in close collaboration with government partners.
Primary Data Collection
Based on the nutrition programme goals, gaps identified during the desk review, inputs from
stakeholders, and real-life parameters (e.g. budget, time frame and context) primary data
collection should be an essential activity of Step 1.
Keep in mind that primary data collection in formative research should not be a comprehensive
study of the entire food and health environment for a given context.
Instead, primary data collection in formative research should aim to collect the necessary
information for filling in gaps identified during the desk review and the content needed for SBCC
development.
This formative research may include data collection focused on three core components:
sociocultural context, behavioural content, and community engagement.

Figure 7. Examples of topics that formative research may help generate for SBCC
Sociocultural Context
• Understanding core cultural values
• Generating language considerations
• Mapping existing health and nutrition services
Behavioural Content
• Identifying barriers and facilitating factors to behaviours
• Describing current knowledge, attitudes, and dietary practices
• Outlining audience profiles
Community Engagement
• Building rapport and gaining community buy-in
• Identifying preferred communication channels
• Soliciting feedback on SBCC materials prior to implementation
This type of primary research should typically be conducted by consultants with research
expertise and/or research experts from academia (e.g. Johns Hopkins Center for Communication
Programs) or professional behavioural change organizations (e.g. Claremont Communications,
PCI Media Impact). Some NGOs, such as Population Services International, also have this type of
expertise and can be considered during recruitment.
Research design
Deep anthropological work is typically not necessary or feasible in WFP nutrition programmes.
Due to the nature of WFP nutrition programmes, where resources and timelines are abbreviated,
any primary data collection during formative work would benefit from following a Focused
Ethnographic Study or Rapid Assessment Procedures approach (Scrimshaw and Gleason, 1992;
Scrimshaw and Hurtado, 1987).
Figure 8. Examples of Rapid Assessment Procedures manuals in public health

Such rapid approaches offer iterative and systematic approaches for primary data collection to
be completed in a short time. They are thus well suited for informing WFP nutrition
programming across diverse contexts and can be modified to accommodate various programme
types – from CMAM to stunting prevention.
Data collection
Regardless of the formative research team that has

Useful resource
been hired for the primary data collection, a similar set
of data collection methods should be used by any A draft Rapid Assessment
Procedures (RAP) manual,
organization. specifically written for conducting
formative work to introduce
They should include a combination of both qualitative
specialized nutritious foods in WFP
and quantitative methods designed to complement one nutrition programmes, is available
another. The table below provides a brief description of at OSN and may be adapted for use
in various country contexts.
some data collection methods that should be
considered as part of a formative research toolkit.
Table 4. Examples of formative research data collection methods (Bernard, 2017)
Data Collection Method Description of methodological application
One-on-one, qualitative interview with a caregiver, community

Semi-structured Interviews leader, health worker or other informant, to understand
community-level perspectives.
Listing activity to identify terms specific to a cultural domain,

Free Lists for example ‘young child foods.’ Useful for understanding risk
perceptions and identifying local words for messaging.
Unannounced, structured direct observations useful for

Spot Checks understanding compliance with programme activities, such as
specialized nutritious food utilization in a household.
Sorting activity of cards, each containing the name of a salient

item (for example ‘anaemia’) among community members, to
Pile Sorts identify local classifications useful for message development.
A method for brainstorming and prioritizing programme

activities, such as preferred SBCC channels, among a diverse
Community Workshops group of community members and guided by a qualitatively
trained moderator.
Household-level, structured observations using a checklist or

other form, to understand current nutrition behaviours or
Direct Observations sets of practices – for example, ‘complementary feeding
practices.’
A quantitative questionnaire (e.g. KAP survey), useful for

Surveys assessing self-reported nutrition practices, as well as

knowledge and attitudes, for triangulating with qualitative
findings.
The methods described in Table 3 are not exhaustive but represent some of the key data
collection methods you might expect your research team to use during primary data collection.
Research synthesis
Primary audience segment
One of the primary challenges associated with
The audience segment whose
behaviours are the priority to change. primary data collection during formative research is
For exclusive breastfeeding, the primary the large swathe of information generated from
caregivers will likely be the primary qualitative data collection methods. It is important
audience segment.
that as the WFP nutrition programmer you help
Secondary audience segment guide the research team in report organizing, so that
The second most important audience of the content is immediately useable and relevant.
your SBCC activities. To improve While there is a no ‘one-size-fits-all’ approach to
exclusive breastfeeding you may focus
on influencing husbands, as a secondary
formative research report writing, you might
audience segment, to better support consider ensuring that the following content areas
primary caregivers (Maibach and are included. Categories may vary based on
Parrott, 1995)
programme type, behavioural goals, and WFP
context.
Sample Final Report Outline
Key behaviours to promote
While your programme may have a set of practices you plan to promote, the formative research
should elucidate current knowledge, attitudes and practices related to programme goals.
Therefore, with finite SBCC resources, the final report should highlight the priority behaviours to
promote for achieving nutrition outcomes. It should also describe when to promote certain
behaviours over others, considering context-specific factors such as seasonal food and water
availability, resource constraints, cultural practices and traditions, as well as partner agencies
working in the same area.
Barriers & facilitating factors
For each behaviour, or set of practices, the formative research report should provide a clear
outline of its barriers and facilitating factors, at each level of the socio-ecological model
presented in Chapter 3, figure 2. The worksheet in appendix 1 can be used as a template for
listing the multi-level factors that need to be considered while designing and implementing SBCC
activities.

Audience segment profiles
This section should include a detailed description of each audience segment. It should outline
the primary versus secondary audience segments as well as the unique motivators and
influencers for each group, etc.
Audience segments are an important part of SBCC. For instance, the behavioural determinants
of younger versus older adolescent girls may differ in any one context and therefore will need to
be targeted differently. Formative research should explain these differences.
Communication channels
For each audience segment, there will be specific channels that may most effectively reach it.
The formative research findings should outline those channels that are most appropriate and
preferred by each audience segment. Diagrams are helpful to illustrate key points of contact at
different behavioural levels. The figure below is taken from an SBCC strategy developed for an
integrated stunting prevention programme in Malawi (Kodish, 2013).
Figure 9. Example: Planned SBCC activities and points of contact to key influencers in a WFP-
supported stunting prevention programme in Malawi
Channels used in an SBCC strategy will depend by context. For example, in some settings, SMS
and social media may be a viable channel for reaching caregivers, whereas Care Groups and

radio may be more effective in others. In any programme, a strategic combination of varied
communication channels should be proposed to most effectively reach each audience segment
frequently and at key times (Leslie et al., 2016).
Salient words and phrases for message development
Data from interviews, free lists and community workshops are useful for identifying local terms
and phrases that can be incorporated directly into key nutrition messages that will better
resonate with community members than stock messages. Such terms will help you to develop
tailored messaging for specific audience segments (Noar et al. 2007).
Examples of local terms may include food proscriptions and food prescriptions for each life
stage.
Other considerations
Food proscriptions
Referred to as ‘food taboos’ these are certain foods or food groups that are contraindicated
during particular life stages and derived from cultural rules.
Food prescriptions
Certain foods or food groups that are recommended during particular life stages based on
culturally-ascribed rules (Gittelsohn and Vastine, 2003).
SBCC considerations related to seasonality of foods, water and resource availability, level of local
capacity, previous programme or partner history with SBCC, geographic considerations,
infrastructure for implementing SBCC, etc. should also be included in the report.
Monitoring & Evaluation (M&E)
Research may inform M&E efforts by highlighting information including: field challenges related
to collecting data, indicators suggested for a particular audience segment, local terms and
phrases to be used during survey design, as well as methodological suggestions.
Aligning a final report format ahead of analysis and report writing may help cut down on time
spent back and forth revising and editing its contents, as well as help guide data collection to
cover key topic areas for SBCC strategy development.
Examples of high-quality formative research reports from various WFP country contexts, in
addition to Terms of Reference examples from previous formative activities, are available at OSN
upon request as well as on WFP Go.

Step 2. Develop SBCC strategy with well-defined
SMART objectives
After formative work, the necessary information to develop or refine a specific SBCC strategy
should be available. The SBCC strategy should serve as a ‘blueprint’ for the SBCC activities that
will be conducted. The SBCC strategy should be a concise document that outlines formative
findings, describes target audiences, articulates the channels to reach target audiences, as well
as suggests SBCC timeline, location of activities, potential partners and budget estimates. The
strategy also outlines partnership and monitoring and evaluation considerations, driven by the
SMART behavioural change objectives. The document should be clear and concise, developed
from formative work and in line with WFP programme objectives. Examples from diverse WFP
contexts are available upon request to WFP OSN.
Developing SMART behavioural objectives
The SBCC strategy should be driven by its SMART objectives. These objectives will be imperative
for choosing the most appropriate SBCC activities and will support development of M&E
indicators in subsequent steps. Developing SMART objectives requires understanding the
nutrition programme impact pathway (PIP), outlining how programme outputs and outcomes
will be achieved through planned activities. Once the pathways are clear within the PIP, you
should understand the change you hope to achieve through SBCC, and how SBCC will help reach
programme goals. Choosing these areas of change should be informed by formative findings.
SMART objectives need to be articulated clearly and agreed upon by programme staff and
stakeholders (HC3, 2016). They should take the following SMART format to be most useful.

Table 5. SMART Behavioural Objectives
Specific: Defining who (audience segment), what (specific behaviour or

S psychosocial construct to impact), and where (geographic
consideration) will be important for ensuring specific objectives.
Measurable: Objectives need to be measurable through M&E efforts
M of WFP. While you may want numerous objectives covering a wide

range of topics, keep in mind the ability of your programme to
monitor and evaluate them.
Attainable: Nutrition programmes have finite resources and time

A frames. Be sure that your objectives are achievable considering the
programme parameters.
Relevant: Ensure that SBCC objectives contribute to the overall

R programme goal. SBCC objectives should make sense in the larger
Programme Impact Pathway (PIP) or Logic Model.
Time-bound: Each objective should include a concrete timeframe. For
T example, it may be feasible to improve awareness in two months, but

enhancing IYCF practices require a longer timeframe. As such, each
SBCC objective should have its own timeframe for desired change.
The simple table below (full version found in worksheet form in appendix 3) may help in the
development of SMART objectives.
Table 6. Planning table with simple checklist for developing SMART SBCC objectives
No. SBCC Objective S M A R T
Knowledge
1. In 6 months, 75% of caregivers enrolled in the programme will be X X X X X

able to recall 3 key IYCF messages from the SBCC campaign
2.
Attitude
4.
5.
Self-efficacy
6.

7.
Programme Performance
8.
9.
SMART objectives should cover psychosocial and behavioural domains, including: knowledge,
attitudes, self-efficacy, awareness, subjective norms, intentions, and actual reported behaviours.
They should also cover objectives related to

programme performance, including SBCC
Example of SMART SBCC objective
dose (messages delivered) and reach
(messages received), as well as SBCC Within 6 months of the programme start, 80% of
caregivers of children under 2 years in Afar
programme fidelity (extent to which region (Ethiopia) will indicate their intention to
procedures were implemented as planned) breastfeed until 24 months.
(Kim et al., 2015).
Writing out behavioural chains
You may consider the complexity of human behaviours prior to trying to change them. The
behaviours, or sets of practices, that you wish to improve are typically the result of a series of
behavioural steps that need to be performed without disruption.
Consider the simple behaviour of brushing your teeth, for instance, which still requires at least
six distinct behavioural steps, as well as access to water, toothpaste and a toothbrush:
Step 1 •Deciding to brush your teeth
Step 2 •Opening the toothpaste
Step 3 •Adding toothpaste to the toothbrush
Step 4 •Brushing appropriately
Step 5 •Rinsing the toothbrush
Step 6 •Rinsing your mouth
For nutrition-related behaviours in settings where WFP works, there are typically more steps in
the behavioural chain. For each behaviour of interest, it is useful to write the steps out in order
to think through appropriate SBCC communications objectives. Doing so can help identify
opportunities where SBCC might play a more prominent role to enhance the nutrition
programme.

Behavioural chain in CMAM – an example
In a CMAM programmes, for example, staff may have the goal of ensuring appropriate utilization
of a specialized nutritious food. However, appropriate utilization of food provided has its own
behavioural chain. In such a scenario, caregivers are instructed to provide SuperCereal+, three
times a day, for 90 days. At the distribution site, caregivers may learn how to prepare
SuperCereal+ as well as how to add locally-available, green leafy vegetables and oil to their
porridge.
What seems like a simple message actually involves multiple behaviours on part of the caregiver
to ensure the beneficiary’s (the child) appropriate utilization. For a caregiver to successfully
adhere to this message, she may have to successfully complete all of the following steps:
Food Acquisition
• Travel and purchase vegetables from the local market
Step 1 • Travel to distribution centre with child or children
• Wait in line for SuperCereal Plus
• Travel home carrying 1.5 kg bag of SuperCereal Plus
Meal Preparation
• Gather/purchase firewood
• Start fire
• Get water
• Boil water
Step 2
• Prepare SuperCereal Plus
• Serve child’s portion in a separate, washed plate
• Wash vegetables
• Cook vegetables
• Fortify porridge with vegetables
Ensure appropriate utilization

• Feed the appropriate amount of porridge to the child
Step 3
• Avoid intrahousehold sharing
• Minimize leftovers
Of course, there may be additional steps missing in the CMAM chain above, but the example
should illustrate the many steps (and thus potential for disruption) that exist along any one
behavioural nutrition chain. Social, cultural, and economic factors may cause breaks (e.g.
challenges to practice of behaviours) in this chain, as well as other factors on the SEM.

Not all behavioural steps need to be included in
Invest time now to avoid challenges
SBCC activities, as many of them may already be well later
performed habitually with ease. Therefore, use the
Mapping out the behavioural chain can
formative work to understand what behavioural help you to develop effective SMART
steps would most benefit from targeting by SBCC objectives that anticipate and address
activities. potential barriers to behaviour change.
The comprehensive formative research approach

described above, one that includes a desk review, stakeholder engagement, and community
member inputs through formative research, will contribute to a well-informed, context and
culturally-appropriate, and relevant SBCC programme. In addition, developing SMART objectives
is a crucial step, using formative research findings to move into the SBCC materials development
phase.
Quality Standards - Formative Phase
This checklist is a tool to support WFP staff throughout the Formative phase. The
checklist highlights key steps that should be completed when carrying out work in this
phase, whether alone as WFP or with partners, prior to progressing to the Development
phase.
Yes/No Step 1. Conduct formative work to gather Comments
context-specific information
Formative work includes a desk review,
stakeholder engagement, and primary data
collection.
Mixed methods (both qualitative and quantitative
methods) are used during primary data collection
Formative research is participatory in nature, with

community member involvement
Lists of barriers and facilitating factors are

elucidated for each nutrition behaviour of interest
at each socio-ecological level
Formative work outlines key behaviours to change,

audience segment profiles, preferred channels,
salient words/phrases, and other considerations
Monitoring and evaluation inputs are suggested in

formative findings
Formative Phase
Yes/No Step 2. Develop SBCC strategy with well- Comments

defined SMART objectives
An SBCC strategy is articulated, with channels,

audience segments, and messages outlined based
on formative work.

All objectives are Specific, Measurable, Attainable,
Relevant, and Time-based.
The planning table with simple checklist was used

to develop each SMART objective
SMART objectives cover domains related to

programme performance, psychosocial constructs,
and behaviours
The SMART objectives are created based upon the
formative findings.

References
Bernard, H. R. (2017). Research methods in anthropology: Qualitative and quantitative approaches.

Rowman & Littlefield.
Gittelsohn, J., & Vastine, A. E. (2003). Sociocultural and household factors impacting on the
selection, allocation and consumption of animal source foods: current knowledge and
application. the Journal of Nutrition, 133(11), 4036S-4041S.
Kodish, S. et al. (2011). Understanding low usage of micronutrient powder in the Kakuma
Refugee Camp, Kenya: Findings from a qualitative study. Food and Nutrition Bullettin. 32(3), 292-
303.
Leslie, L., Whang, C., & Arnold, R. (2016). SBCC Best Practices. Available at
https://www.k4health.org/sites/default/files/a_selective_literature_review_on_sbcc_best_practice
s.pdf.
Maibach, E. W., & Parrott, R. (1995). Designing health messages: Approaches from communication
theory and public health practice. Sage.
Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic review of
tailored print health behavior change interventions. Psychological bulletin, 133(4), 673.
Kim, S. S., Ali, D., Kennedy, A., Tesfaye, R., Tadesse, A. W., Abrha, T. H., ... & Menon, P. (2015).
Assessing implementation fidelity of a community-based infant and young child feeding
intervention in Ethiopia identifies delivery challenges that limit reach to communities: a mixed-
method process evaluation study. BMC Public Health, 15(1), 316.
Kodish, S.R. (2013). Social & Behavioural Change Communications Strategy: Ntchisi, Malawi.
Report prepared for the World Food Programme. pp. 1 – 153.
Scrimshaw, S. C., & Hurtado, E. (1987). Rapid assessment procedures for nutrition and primary
health care. Anthropological approaches to improving programme effectiveness.
Scrimshaw, N. S., & Gleason, G. R. (1992). RAP, Rapid assessment procedures: Qualitative
methodologies for planning and evaluation of health-related programmes. International Nutrition
Foundation for developing countries.

Appendix 1. Worksheet for outlining determinants of key behaviours
Key behaviour #1: Description Behavioural

Determinants
Individual level Knowledge, perceptions, socio-economic status,
physiological status, level of risk perception, self-
efficacy, attitudes, etc.
Interpersonal level Encouragement, subjective norm, direct and

indirect social influences, including influences of in-
laws, husbands, family and community members
Organizational level access issues, including far distances and high

health care costs, as well as the quality of care
provided by schools, hospitals, clinics, etc.
Community level Social norms, livelihoods, core cultural values,

geographic location, religious affiliation, kinship
structure, socio-economic status, etc.
Policy level Policies and guidelines at international, national,

and sub-national levels

Determinants
physiological status, level of risk perception, self-
efficacy, attitudes, etc.

indirect social influences, including influences of in-
laws, husbands, family and community members


Policy level Policies and guidelines at international, national,

and sub-national levels

Determinants
physiological status, level of risk perception,
self-efficacy, attitudes, etc.

indirect social influences, including influences of
in-laws, husbands, family and community
members


Policy level Policies and guidelines at international,

national, and sub-national levels

Determinants

members




Determinants

members




Determinants

members




Appendix 2. Template for organizing desk review findings
Directions: During a desk review, you should collect all relevant secondary data sources that may inform your SBCC strategy. The simple table below
may then help you to organize the information before making programmatic decisions. It will also help you to identify where there are gaps that need
to be addressed through primary data collection.
Source Type Behaviour Audience Barriers Facilitating Implications for SBCC materials
Factors
1.
2.
3.
4.
5.
6.

Appendix 3. Checklist for developing SMART indicators
Directions: Use this table to develop and check appropriate indicators for your SBCC campaign.
You may add or delete rows for any domain depending on its relative importance to your
programme.
SBCC Objective S M A R T
KNOWLEDGE
In 6 months, 75% of caregivers enrolled in the programme will X X X X X
be able to recall 3 key IYCF messages from the SBCC campaign
ATTITUDES
SELF-EFFICACY
SUBJECTIVE NORM
BEHAVIOURS
PROGRAMME PERFORMANCE

Chapter 6. Development Phase
Purpose:
The purpose of this chapter is to orient WFP staff to Steps 3 and 4 of the SBCC development
process. These two critical steps bridge the gap between formative work and programme
implementation. Step 3 focuses on the use of creative briefs for translating formative findings
into SBCC materials and Step 4 underscores the importance of pre-testing SBCC materials prior
to programme implementation.
• Recognize the importance of this development phase for SBCC programmes

• Understand what a creative brief is, and how it can be used to generate SBCC materials
from formative findings
• Describe why and how pre-testing of SBCC materials among audience segments should
be done prior to programme implementation
Photo 7: WFP programme staff, especially those who distribute specialized nutritious foods
directly to beneficiaries, are important influencers to consider during SBCC planning

Overview - Development Phase
The development phase is a critical link between SBCC formative work and programme
implementation. It requires WFP Nutrition staff to ensure that formative findings from Steps 1
and 2 are fully represented in Steps 3 and 4 as SBCC materials are created and tested. This
phase will provide guidance on developing creative briefs, which are the templates for
communications experts and agencies to develop tailored SBCC materials based on formative
findings. The development phase also is an important time to pilot-test those materials prior to
implementation.
Figure 10. SBCC development process, Development Phase

Formative
Phase
• Step 3. Draft creative briefs from formative work to develop SBCC material
Development
Phase

Programming
Phase

Monitoring
Phase

Step 3. Draft creative briefs from formative findings to
develop SBCC materials
The creative brief is the backbone of developing a more effective SBCC campaign that is tailored
to the local context, population, and WFP programme (Alstiel and Grow, 2015).
This step benefits from the expertise of a consultant or a small team with an understanding of
formative work, nutrition content, and SBCC principles, as the creative brief is intended to bring
all of these aspects together.
Creative brief
By providing the creative agency that will support SBCC
Document created from formative
materials development with clear instructions through
work to guide the design and creation
creative briefs, WFP will help ensure that the formative of SBCC materials for use during
work is reflected in the nutrition programming. implementation.
Creative briefs often take slightly different forms depending on the type of planned SBCC
activities, but they generally should include similar content areas. Appendix 4 includes a
template that can be used during this step.
Photo 8: Creative briefs should contain all the information necessary for an agency to develop
content for tailored, culturally-appropriate SBCC materials

Table 7. Domains to include in a creative brief to inform SBCC materials
Content Area Description
Communication The medium through which messages are delivered

Channel
The audience segment on which the brief focuses on, for instance
Intended Audience female caregivers, community leaders, or school-aged boys
The specific SMART goal that the brief addresses

Objectives
Logistical, resource-based, training, and other related factors of overall

Potential Obstacles ease/difficulty of implementation
The specific, tailored messages that are to be delivered through the

Tailored Messages channel identified above
The general feeling or attitude to be conveyed through the piece

Tones
The locations or opportunities in the nutrition programme and local

Openings setting to introduce messages through channel above for timely reach
Other factors for the creative agency to consider during creation of

Other creative SBCC materials, for instance preferred colours to use in print media or
considerations ‘creative hooks’ to emotionally resonate with audiences
Suggested dose of activities to be delivered during programme

Minimum standard of implementation (e.g. number of radio spots to buy and frequency of
implementation airing them)
Two critical areas of the creative brief are the choice of communication channel and the
development of messages.

Choosing Communication Channels
A communication channel is the medium through which messages will be delivered to

beneficiaries. There are many channels from which to choose depending on the SBCC approach
used. Each channel has strengths and limitations,
Audience profile
therefore should be used in combination with others for
maximum reach and comprehension. Choosing Detailed descriptions of specific
communication channels can be done in conjunction target audiences used for informing
the development of appropriate
with the development of detailed audience profiles
SBCC approaches and messaging
which describe key audience segments in detail based contents.
on formative findings (appendix 5).
Different channels are appropriate in different contexts and among unique audience segments
(Graziose et al., 2017). Whereas social media may have potential for successfully communicating
to adolescents in middle-income countries, Care Groups may work better among female
caregivers in low-income settings (Wilner et al., 2017). The table below outlines considerations for
SBCC channels by level of influence.
Table 8. Considerations of SBCC channels and their level of influence
SBCC Socio-ecological
Approaches & level of primary Brief overview and considerations
Channels* influence
Interpersonal Approaches
Interpersonal approaches are effective for engaging

• Counselling • Individual individuals in two-way communication that can offer
• Support groups • Interpersonal more tailored, individual advice as well as address
sensitive topics.
Media Approaches
Mass media (national radio) may be used as a one-

way communications approach to reach entire
countries or regions, whereas mid-sized media
(billboards) may be better for district-specific
activities.
• Mass
• Mid-sized • Interpersonal
• Print • Community Print media (e.g. brochures) are appropriate in
• Traditional • Organizational contexts where literacy is high, and traditional media
• Social (e.g. theatre) may work where existing structures are
in place to relay community-level information.
Social media (e.g. Facebook, SMS) may be useful for

two-way communication with adolescents and others

(e.g. smallholder farmers) who rely on sharing
information through technology.
Community Mobilization Approaches
Community/social mobilization requires active

participation and empowerment of all sectors of a
• Campaigns community to catalyse action at this level.
• Issue groups
• Community
• Outreach May include any number of mobilization approaches
• Health fairs to raise awareness, build collective efficacy, foster
empowerment, and create an enabling environment
for change.
*Not an exhaustive list of activities/examples
Photo 9: Job aides help health workers lead discussion on key nutrition concepts as a way to
tailor messaging to beneficiaries
When considering
which
combination of
channels to use,
consider the
following factors
based on the
formative phase
described in
Chapter 5.

Table 9. Context-specific considerations when deciding upon appropriate channels
Socio-Cultural Factors SBCC is both an art and a science

• Audience segment preferences: What channel or combination of channels will best reach
Deciding upon channels is not always
each audience segment at key times?
straightforward, but you can always
adjust channels later based on
• Language considerations: What level of literacy exists in this context? Is the main language
programme monitoring information.
written or spoken? Should the national language be used for communications or also local
languages?
• Existing infrastructure available: Does the telecommunications infrastructure exist to use

SMS as a primary channel? Are the road conditions adequate during rainy season to ensure
timely delivery of messages?
Programme Factors
• Budget availability: Is enough money available to use mass media? How many print materials
can be developed and disseminated based on the budget? How can the budget cover both
media and interpersonal approaches?
• Timeline: Will the channel be appropriate considering the programme lifecycle? What channel
is most appropriate considering different seasons across the programme?
• Partner capacity and level of support: What implementing partners are available to support
delivery through this channel? How much training will be required to use Care Groups in this
setting?
Communication factors
• SMART objectives: What channel best delivers the messages vis-à-vis the SMART objective
identified? What channel can deliver the level of message persuasion needed?
• Type and complexity of messaging: Are narratives and explanations needed to convey key
messages or will simple messages be sufficient? Is two-way or one-way communication needed?
• Ability to influence at multiple socio-ecological levels: Do these channels adequately impact

at individual, interpersonal, community and orgnaizational levels?
Therefore, choosing channels does not have to be a permanent decision in the beginning of
SBCC planning. The worksheet in appendix 6 may be used for planning purposes in making
appropriate channel choices.
Developing theory-driven messaging
Too often, nutrition programmes ineffectively deliver textbook-like messages focusing on the
biomedical benefits of engaging in a particular nutrition behaviour. Nutrition-related behaviour
is too complicated for such a basic approach.

Message generation should be grounded in behaviour
Not all messages resonate with
change theory. The Persuasive Health Message (PHM)
everyone
framework is useful to generate a theory-driven SBCC
People often respond differently to campaign for increasing the likelihood of changing
the same information, depending on
behaviours (Witte and Allen, 2000). Refer to appendix 7
who they are, what motivates them,
how it is delivered, etc. (Moyer-Guse, for examples of tailored messages from a WFP-
2008). supported project in Malawi (Moyer‐Gusé, 2008).

Figure 11. Persuasive Health Message framework for tailoring SBCC messages
CONSTANTS TRANSIENTS
Threat
- Susceptibility
- Severity Message Goals
Salient Beliefs
Efficacy Salient Referents
- Response Efficacy
- Self-Efficacy
Persuasive
Cues
Message
- Message
- Source Culture
Audience Profile Environment
- Demographics Preferences
- Psychographics
- Customs, Values
The PHM is relevant for WFP Nutrition since many nutrition-related illnesses are often not
perceived to be as serious as other common illnesses, such as malaria, in low- and middle-
income settings (Kodish et al., 2014).
PHM has several variables to consider but, in brief, suggests that sets of persuasive messages
should reflect the following four points:
Messages should increase beneficiaries’ perceived threat

Threat
(susceptibility and severity) of nutrition-related illnesses
Messages should provide beneficiaries with feasible
Efficacy behavioural solutions to address nutrition illnesses and
effectively avert perceived threats
Well-crafted messages based on persuasive
Cues communication principles serve as cues to action to
motivate behaviour change
Tailored messages to the local socio-cultural contexts for
Audience Profile each audience segment will resonate more than generic
messages

Not every message should include a threat message or invoke a fear appeal. Without a heighted
risk perception toward nutrition-related illnesses, the likelihood of behaviour change is reduced.
Suggested steps for tailoring messages
Follow the steps below for developing tailored messaging:
STEP 1
Choose a generalized nutrition message from global and/or national guidelines
STEP 2
Identify the behaviour, or set of practices, to achieve desired nutrition
outcomes
STEP 3
Review the formative findings and relevant literature to identify potential
season- and context-specific barriers to successful completion of this behaviour
STEP 4
Tailor each message using the information from Steps 1 – 3 above and then
combine with a key construct from persuasive communications. The
following principles from social psychology are useful for making messages more
persuasive (Stiff and Mongeau, 2016):
• Social proof: People are more likely to do what others who are similar to
them do. Therefore, a message may resonate if it alludes to the behaviours of
others who they perceive to be similar, perhaps from the same community.
• Behavioural inoculation: A forewarning against a threat to existing

attitudes allows someone to build a mental defence against it. Framing a
message that warns someone what may constrain her behaviour allows her to
build a defence against it ahead of time.
• Overcoming barriers: Offering a clear solution to an expected barrier in

messaging helps beneficiaries overcome barriers identified during
formative work. Similar to behavioural inoculation, this type of message
warns a beneficiary of an expected barrier. However, it also offers a clear and
specific solution to that barrier.
• Fear appeal: A message that invokes fear in order to divert behaviour

through the threat of impending harm or risk. For effectiveness, a
message with a fear appeal needs to have a salient consequence for a
beneficiary not engaging in that behaviour.
• Scarcity: Things become more desirable when they are in great demand
but in short supply. For example, communicating the message that the first
1,000 days of life are a critical window of opportunity may influence utilization
of services if beneficiaries know the chance for impact is temporary.

• Gaining benefits: An individual’s assessment of the positive
consequences from undertaking a behaviour. Appealing not only to the
nutritional benefits of a WFP nutrition programme but also its possible
indirect benefits, such as saved money on health care costs for a household,
may resonate more effectively with beneficiaries.
• Appealing to positive affect: This concept refers to the extent that a

person experiences positive emotions such as joy. Making explicit the
benefits of a nutrition programme to a mother’s infant may appeal to a
mother’s positive affect.
• Commitment and consistency: If people commit to a goal, they are more

likely to keep that commitment. Utilizing the public commitments of
community leaders to mobilize direct beneficiaries for increasing programme
coverage is one example; commitments may be followed up by messages to
leaders for reinforcement, though.
• Authority: People generally defer to those in authority and follow their

advice or suggestions. In messaging, overtly stating that people in positions
of authority (e.g. community leaders) promote key behaviours may enhance
the likelihood that the behaviour will be carried out appropriately by
community members.
• Liking: Individuals tend to be persuaded by other people that they like.

Crafting messages so that they mention other people they like in those
messages is one way to persuade them of a behaviour. If community health
workers are well liked in a certain context, then they might be included in
messages promoting certain nutrition behaviours.
STEP 5
Incorporate local, salient terms identified during the formative work into
messages
STEP 6
Translate messages into local languages. If the meaning of a message is lost in
translation then the persuasion will likely also be lost and render messages less
effective – therefore, careful translation is required.

Adhering to this systematic approach, based on principles of health communication, will
help ensure that the SBCC campaign is grounded in sound behaviour change theory and
increase the likelihood of programme success to positively impact upon nutrition
behaviours.
Refer to Appendix 7 to see a page of tailored messages developed for SBCC activities in a
WFP-supported stunting prevention programme in Malawi. Notice the tailoring based on
seasonal considerations, persuasive language constructs, context-specific barriers, and
key words/terms identified during the formative work.
Step 4. Pre-test SBCC materials among target audience

segments
Once SBCC materials have been created, the next step involves pre-testing them before
finalizing. This step is critical and must not be overlooked (Lapka, 2008).
The purpose of pre-testing is to solicit feedback from a sub-sample of beneficiaries from a

relevant target population. Revisions to SBCC materials are needed when feedback indicates red
flags signifying that changes should be made prior to implementation.
Key areas to identify during pre-testing:
• Misinterpretations of content
• Negative perceptions of content
• Inappropriate images
• Complex/confusing/conflicting message content
The pre-testing process will be essential to finalize the SBCC creative briefs which may require
some changes after both stakeholder and community feedback (HC3, 2013).
How to pre-test SBCC materials
Understanding, pretesting, and agreeing upon the most appropriate SBCC materials should
involve a few key steps.
Stakeholder Qualitative Revisions of Stakeholder

Meeting Feedback SBCC Materials Meeting

1. Stakeholder meeting – Initial presentation of SBCC materials
As part of the stakeholder engagement process, the WFP team should involve key stakeholders
in two rounds of technical meetings related to SBCC
Stakeholder meeting development. The initial meeting should occur
15 - 25 people representing immediately after the development of materials and
government, WFP, partners, private messages. During this meeting, stakeholders will have
sector, civil society, etc. as relevant to
the opportunity to view draft SBCC materials and
each context.
messages, provide key technical inputs and
suggestions for revisions, and build consensus about their overall appropriateness. A ‘how to
conduct a stakeholder workshop’ instructional guide is available (Health Compass, 2017).
2. Qualitative feedback
After gaining stakeholder feedback, or concurrent to those efforts, the drafted SBCC materials
should be pre-tested among the key audience segments in the beneficiary communities. Two
qualitative methods are helpful for doing so:
Semi-structured interviews
Semi-structured interviews should be used to solicit feedback from beneficiaries in a one-on-one

format. They should begin with discussions that aim to gauge the perceptions of beneficiaries
toward the SBCC materials (Eisenbruch, 1990).
Using an interview guide, specific questions should then identify the factors related to
acceptance or rejection of the drafted SBCC materials, messages, or images, as well as areas
where the materials can be modified for improvement (Bernard, 2017).
The interviews should be led using semi-

General Pre-testing Sampling Guidance
structured guides and conducted among
caregivers, community leaders, health workers, Interviews
and other important audience segments (such Purposefully sample 3–5 individuals per audience
as adolescents) depending on the nutrition segment. With just one or two audience segments
then you can consider sampling 6–8 people per
programme. Appendix 8 has an example of a segment, depending on timeline and resources.
semi-structured interview guide that can be
Focus Groups
used in monitoring.
Organize 2–3 groups per audience segment, with 6–
Focus group discussions 10 similar people participating in each group.
Consider 3–5 groups per segment if the programming
While interviews will provide personal opinions, context allows for it.
focus group discussions will yield group-level *Detailed sampling considerations provided in appendix 10
feedback that tends to better reflect social
norms. Focus groups are effective tools for identifying social norms not only in public health, but
also in marketing research (Kitzinger, 1994).

Focus groups should begin with a less structured approach that emphasizes free discussion
around the SBCC materials and then moves toward a more structured discussion of specific
aspects such as messages.
Just like the interviews, the focus groups should be guided by semi-structured moderator guides
(appendix 9). Since SBCC materials should be tailored to individual audience segments, they
should also be pre-tested among individual audience segments.
3. Revisions of SBCC materials based on feedback

Feedback from focus groups should be combined with that of interviews and stakeholders to
comprehensively allow for modification of SBCC materials. Findings should be collated in a
collaborative process involving the SBCC team, WFP team, and the illustration team that includes
the graphic designer and illustrator.
During this step, strategic decisions will be made for modifying the SBCC materials and
messages, using the most efficient and necessary actions. A near-final set of materials should be
produced as a result of this process.
4. Participatory stakeholder meeting – follow up and consensus building

As the final step in the pre-testing process, a second meeting among key stakeholders should be
held. This second meeting will allow for review of the modified SBCC materials and messages. It
will also serve as a forum to explain the inputs of the community to stakeholders. The purpose
of this second meeting is to build final consensus and align stakeholders around the SBCC
materials prior to programme launch. It is a chance for final review of SBCC materials, and will
provide the opportunity for all stakeholders to take responsibility as well as be accountable to
the planned SBCC activities.

Quality Standards - Development Phase
This checklist is a tool to support WFP staff throughout the Development phase. The
phase, whether alone as WFP or with partners and consultants, prior to progressing to
the next Programming phase.
Yes/No Step 3. Draft creative briefs from Comments
formative findings to develop SBCC
material
This phase is led by someone, or a
team, with experience in nutrition,
social and behaviour change, and
communications
A creative brief is completed for each
communication channel and based on
findings from the formative phase.
A justified combination of approaches
(interpersonal, media, and
mobilization) was chosen to reach
audience segments at different
behavioural levels
A unique set of tailored messages for
each audience segment are provided
Tailored messages are developed
based on the six-step process outlined
in step 3 of this guidance
All messages are technically accurate
from a health and nutrition perspective
Messages are context-appropriate for

the channels chosen and audience
segments (language, complexity, etc.)
Yes/No Step 4. Pre-test SBCC materials Comments

among target audience segments
A stakeholder meeting is held at the

beginning of this step to introduce
SBCC draft materials
Development Phase
Qualitative data collection using both

interviews and focus groups occurs
among key audience segments
Refinements and modifications are
made to the SBCC materials based on
feedback by stakeholders and
community members
end of this step to build consensus
around revised SBCC materials prior to
launch

References
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strategic communication. Baltimore: Johns Hopkins Bloomberg School of Public Health Center
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Health Compass. (2017). How to conduct a stakeholder workshop. Available at

https://www.thehealthcompass.org/how-to-guides/how-conduct-stakeholder-workshop
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Kodish, S., Aburto, N., Dibari, F., & Gittelsohn, J. (2014). Differential Risk Perceptions toward
Illness guide development of a prevention of stunting intervention in rural Mozambique (LB477).
The FASEB Journal, 28(1 Supplement), LB477.
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effects of entertainment‐education messages. Communication Theory, 18(3), 407-425.
Stiff, J. B., & Mongeau, P. A. (2016). Persuasive communication. Guilford Publications.
Wilner, L., Suri, D. J., Langlois, B. K., Walton, S. M., & Rogers, B. L. (2017). Effective delivery of
social and behavior change communication through a Care Group model in a supplementary
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Witte, K. & Allen, M. (2000). A meta-analysis of fear appeals: implications for effective public
health campaigns. Health Education and Behaviour.

Appendix 4. Creative brief template – example used to create a banner
1. Medium of Communication
• Banner
2. Intended Audience and Responsible Party
• Primary audience: Prospective beneficiaries - The banner is meant to be displayed at
each of the six or seven registration sites per cluster so it will be messaging to
prospective beneficiaries as they arrive at the health centres and extended
distribution points.
o The cooperating partner is responsible for coordination of reproduction of
banners through its creative agency or an external creative agency.
3. Objectives
• To convey the official nature of the registration process
• To let mothers know that they are in the correct spot for registration
• To let mothers know where to go to register once they arrive at the health centre or
extended distribution point
4. Content of the Banner
• Government Logo
• SUN 1000 Special Days United to End Stunting Logo
• Culturally-appropriate image of a mother feeding an age-appropriate baby under two
years, either breastfeeding or complementary feeding
• The phrase “Now Registering” in local language
• Any other relevant banner content appropriate for this setting.
5. Tone
Positive, Official, Bold
6. Openings (Opportunities to deliver a message using this medium)

• These should be displayed at each health centre and extended distribution site during
the actual days of registration in each cluster.
7. Creative Considerations
• The banner should be large enough so that there is no mistake that this is an official
registration. It should have vibrant, culturally-appropriate colours with only the
essential information. It should not have logos of WFP or the cooperating partner so
that the community does not associate this as a “WFP programme” for example. It is
meant to be perceived as a movement rather than a programme and should be
affiliated with the government rather than a donor or implementing agency.
8. Minimum Standard of Implementation
• Seven banners are needed since there may be up to seven places of registration per
cluster at any one time. An extra banner could be produced if funds allow

Appendix 5. Audience Profile worksheet
Directions: Use this table to describe important communications considerations for each
audience segment. Doing so will help you to understand how to tailor SBCC activities.
No. Category Audience Segment Name: _______________________
Descriptions:
1. Demographic information
2. Key behaviours to change
3. Level of relevant knowledge
4. Attitudes toward behaviour
5. Level of self-efficacy
6. Emotional hooks
7. Preferred channels
8. Barriers to changing
behaviours
9. Facilitating factors to
changing behaviours
10. Other unique characteristics

of this audience segment

Appendix 6. Planning matrix for assessing communication channels
Directions: The planning table below may help you to outline potential channels of communication to use during SBCC activities. In any one setting,
you will have many potential channels to choose for messaging, so planning is important for ensuring that choices best reach target audiences cost-
effectively.
Potential SBCC Primary Secondary Expected Reach Cost Other considerations (seasonal challenges,
Channel Approach Audience Audience of Channel trainings necessary, etc.)
1.
2.
3.
4.
5.
6.

Appendix 7. Examples of tailored messages after formative work- integrated stunting
programme
Pregnant and Lactating Women
• Today, ensure that your wife consumes different food groups for the healthy growth and
development of your baby.
• Community leaders advise taking advantage of a non-rainy day to go to the health clinic for
your pregnancy check-up during this season.
Exclusive Breastfeeding Messages
• Happy families use breast milk—a free food for the baby.
• Breast milk helps prevent against frequent illness such as diarrhea and fever.
• To have a baby who is happy, gaining weight, and not getting sick frequently, continue to
breast feed him even during illness.
Complementary Feeding Messages
• Other mothers in Ntchisi are able to raise babies who gain weight during the lean season by
breastfeeding until two years.
• With fewer food options right now, HSAs recommend that you should breast feed until two
years for a healthy baby.
• Thinning out porridge for young children will lead to a lack of food in the body.
• To help your baby avoid a lack of food in the body, be sure to prepare porridge that is thick
with groundnut flour or soya.
• Providing a child 6 – 23 mo. with his own bowl for eating will help his healthy growth and
development.
Nutributter® Messages
• Nutributter is a tasty nutrition supplement for healthy growth and development: one sachet,
one day, one child.
• In times of food shortage, do not forget your public pledge to your community/village that you
will provide Nutributter® only to your baby 6-23 mo.
• Safely store Nutributter® where it cannot be stolen to help your baby avoid a lack of food in
the body.
• Use Nutributter® to prevent malnutrition just as you use insecticide-treated bed nets to
prevent malaria this time of year.
• Health surveillance assistants advise giving Nutributter® to your baby after breastfeeding away
from other children.
• Prior to the harvest, food conservation may be challenge, but remember Nutributter® is not a
replacement for other foods for your baby.
• Community members strongly disapprove of caregivers who snack on the baby’s Nutributter®.
• Other mothers in Ntchisi feed their babies directly out of the sachet when they do not have
extra maize flour to make porridge during lean season.
Water and Sanitation Messages
• Your baby may get sick frequently if you do not wash your own hands and his hands prior to
eating each meal.
• Ensuring that you wash your hands and your baby’s hands before eating may help you to avoid
long trips to the hospital during rainy season.
• Other community members find that hand washing prior to eating reduces a baby’s frequency
of diarrhea and may help you to save money on health care.

Appendix 8. Semi-structured interview guide – pre-testing messages
Introduction
Thank you for meeting with me today. I would like to start by asking you about your community.
Could you describe your community for me since I am not from this area?
OK, thank you – that description was very helpful. Now I would like to introduce some program
materials that we developed and hope to incorporate as part of a new nutrition and health
project. I will introduce first some ideas related to strategies for communication of health
messages in your community. I would like to hear your opinions about how good or bad you
believe the ideas are. Also, I would like your honest feedback about ways to improve upon our
ideas.
Part 1. Introducing SBCC specific messages
I have some messages related to nutrition. Let me introduce them one by one and then I want to
hear your feedback.
Introduce nutrition messages one-by-one to the participant.

• Question 1. Tell me what this message means to you?
• Question 2. Describe whether you can understand this message clearly. If

not, explain where the confusion lies.
• Question 3. Explain how easy/difficult it would be for you to follow this

message based on your current situation. Probe on why/why not.
• Question 4. Suggest any way that we could revise this message to make it
clearer or more appropriate for your community. Probe for specifics.
Part 2. Introducing SBCC images
I have some images/illustrations related nutrition. Let me introduce them one by one and then I
want to hear your feedback, just like we did with the messages.
Introduce nutrition-related images/illustrations one-by-one to the participant.

• Question 1. Tell me what this image means to you?
• Question 2. Describe whether you can understand this image clearly. If not,
explain where the confusion lies.

image message based on your current situation. Probe on why/why not.

• Question 4. Suggest any way that we could revise this image to make it
clearer or more appropriate for your community. Probe for specifics for
revisions to inform the graphic designer/illustrator.
Part 3. Introducing SBCC strategies
Finally, we hope to introduce these messages through various channels.

• We aim to introduce messages firstly through mass media such as radio.
Describe whether doing so will be appropriate in this setting?
• Also, we will use community meetings. Talk about how appropriate this
channel is for this community?
• Etc…Introduce all other channels of communication or related BCC strategies to

get feedback from the participant through this Part 3 section one-by-one until
finished.
Closing
• Now that you have seen all of these SBCC materials, could you explain
whether you believe they will be, in general, useful, effective and
appropriate for your community? Probe why/why not.
Thank you so much for your inputs today. Do you have any additional questions or inputs
related to these SBCC materials?

Appendix 9. Focus group discussion guide – pre-testing messages
Introduction
Thank you for meeting with me today. I would like to start by asking each of you to introduce
yourself by going one-by-one around the circle.
OK, thank you – those introductions were very nice. Now I would like to introduce some program
materials that we developed and hope to incorporate as part of a new nutrition project. I will
introduce first some ideas related to strategies for communication of health messages in your
community.
I would like to hear your opinions about how good or bad you believe the ideas are. Also, I would
like your honest feedback about ways to improve upon our ideas. Remember, there are no right
or wrong answers during our discussion today. I am just hoping to learn about areas of
agreement and disagreement in relation to the ideas I present today. If you disagree with
something someone else says, then please say so. Also, I ask that only one person speaks as a
time.
Part 1. Introducing SBCC specific messages
I have some messages related to nutrition. Let me introduce them one by one and then I want to
hear your feedback.
Introduce nutrition messages one-by-one to the focus group.

• Question 1. Tell me what this message means to you? Does everyone agree?
• Question 2. Describe whether you can understand this message clearly. If

not, explain where the confusion lies.

message based on your current situation. Probe on why/why not.
• Question 4. Suggest any way that we could revise this message to make it
clearer or more appropriate for your community. Probe for specifics.
Before moving to the next message, be sure to build consensus among the group about the
appropriateness of the message and/or areas for modification.
Part 2. Introducing SBCC images
Next, I have some images/illustrations related to nutrition. Let me introduce them one by one
and then I want to hear your feedback, just like we did with the messages.

Introduce nutrition images/illustrations one-by-one to the focus group.
• Question 1. Tell me what this image means to you? Does everyone agree?
• Question 2. Describe whether you can understand this image clearly. If not,
explain where the confusion lies.

image message based on your current situation. Probe on why/why not.
• Question 4. Suggest any way that we could revise this image to make it
clearer or more appropriate for your community. Probe for specifics for
revisions to inform the graphic designer/illustrator.
Before moving to the next message, be sure to build consensus among the group about the
appropriateness of the message and/or areas for modification.
 Part 3. Introducing SBCC strategies
Finally, we hope to introduce these messages through various channels.

• Example: We aim to introduce messages firstly through mass media such as
radio. Describe whether doing so will be appropriate in this setting? Does
everyone agree?
• Also, we will use community meetings. Talk about how appropriate this
channel is for this community? Does everyone agree?
• Etc…Introduce all other channels of communication or related SBCC strategies to

get feedback from the group through this Part 3 section one-by-one until finished.
Before finishing, be sure to build consensus among the group about the appropriateness of the
strategies/channels and/or areas for modification.
Closing
• Now that you have seen all of these SBCC materials, could you explain
whether you believe they will be, in general, useful, effective and appropriate
for your community? Probe why/why not.
Thank you so much for your inputs today. Do you have any additional questions or inputs
related to these SBCC materials?

Appendix 10. Sampling considerations during pre-testing of SBCC materials
Stakeholders
Stakeholders should be invited to the two technical meetings during the pre-testing process.
Stakeholders should be invited from Ministry of Health, private, and public sectors, including civil
society. WFP should work with government to develop a list of these stakeholders for invitation.
The number of stakeholders will be between approximately 15 and 25 people.
Participants
Overall, qualitative pre-testing should use stratified purposeful sampling methods to arrive at
sample sizes for each audience segment. Smaller sample sizes than those that were used during
the formative research are needed during this pre-testing phase. Stratified purposive sampling
will be used to insure inclusion of different voices and perspectives. Below are some suggested
sample sizes for qualitative data collection by methodological choice.
Semi-structured Interviews
Community leaders (n = 3 - 5)
Community leaders wield a lot of power in many settings where WFP works and therefore should
be included to some extent in the SBCC materials and messages pre-testing process. A small
sample size is adequate because the purpose is to involve these leaders through the process
more than to solicit their specific feedback. Gaining their approval and support is critical for
social and behaviour change.
Beneficiaries (n = 5 – 8 per audience segment)
Because beneficiaries will be the recipients of the SBCC materials and messages, it is critical that
they are sampled for interviews. By sampling 8 – 12 beneficiaries then enough data should be
collected for pre-testing. Efforts should be made to sample by age and gender of beneficiaries in
each audience segment, among other characteristics deemed important, as necessary.
Programme Implementers (n = 5 – 8 beneficiaries)
It is important that feedback should be sought among SBCC activity implementers (e.g. health
staff). Sampling health workers at various levels, including those that are doctors, nurses, and

health workers will be important for elucidating perceptions toward SBCC materials and
messages at various occupational levels. An emphasis should be placed on sampling individuals
who will be responsible for actually communicating the health messages on the frontline of
programme activities.
Focus Groups
Each audience segment (n = 3 - 5 focus groups per audience segment)
Focus groups provide information on social norms and are very useful for building consensus. It
is important that SBCC materials and messages are introduced as stimulus aides during focus
groups to evoke feedback by those who will use those materials during the programme. Each
focus group should include no more than 6 – 10 people at the same level. That is, one focus
group may include only community health workers, while another may include only doctors. A
focus group should not include both doctors and community health workers because then the
voices of some individuals may not be heard due to power differences. Both male and female
groups should be conducted in order to allow for comparisons by gender and geographic region
where relevant.

Chapter 7. Programming Phase
Purpose:
The purpose of this chapter is to explain Steps 5 and 6 within the Programming Phase of
SBCC design and development. These steps cover the training (Step 5) and implementation
(Step 6) processes needed to commence SBCC activities. Once the formative and
development phases are completed, programme activities begin. This chapter outlines
considerations for a WFP programme that involves SBCC activities.

• Explain key considerations when conducting trainings for SBCC activities
• Understand how formative and development phases inform programming
• List the functional components of an SBCC programme
• Understand how to identify partners for SBCC activities
• Understand key considerations for training staff in SBCC activities
Photo 10: Implementation of SBCC activities, such as this social mobilization event, pictured
above, requires careful planning and coordination

Overview – Programming Phase
The programming phase is the product of the up-front work conducted during Steps 1–4.
The application of SBCC activities will vary

across different WFP programmes and thus The programming phase is a culmination of
stakeholder engagement, formative work, and
should be modified accordingly. The way that
other preparatory work needed to implement
SBCC activities are applied to CMAM will be a culturally-appropriate and effective SBCC
different from their implementation in a campaign to positively influence nutrition
behaviours and social norms.
stunting prevention programme, for instance.
This chapter outlines overarching considerations for SBCC training and implementation.
Figure 12. SBCC development process, Programming Phase
•Step 1. Conduct formative work to gather context-specific information

Formative
•Step 2. Develop SBCC strategy with well-defined SMART objectives
Phase
Development
Phase

Programming
Phase

Monitoring
Phase

Step 5. Train staff for effective implementation of SBCC
campaign
Training staff is important for ensuring a successful SBCC campaign (HC3, 2013). It is not a one-
time activity only at the beginning of a campaign, but a continual process throughout the
lifecycle of a nutrition programme.
Trainings will vary by context but should have the following considerations (HC3, 2014; Strauser
and Neusy, 2010):
 Guided by clear learning objectives
 Be engaging and participatory
 Be culturally appropriate and context-specific
 Use varied pedagogical approaches
 Evaluate trainee knowledge and skills
 Be gender sensitive
 Solicit feedback to improve future trainings
Some level of training is always needed for SBCC implementers to effectively deliver messages
across channel types.
Training by channel
Interpersonal
Interpersonal communications have the benefit of influencing beneficiaries at the individual

level, with tailored messages in response to each beneficiary’s unique situation.
Often, the individuals delivering interpersonal

Interpersonal approaches
messages are community members, themselves. In
Interpersonal approaches, in particular,
such cases, these social influencers may include
require well-trained staff who are able
to be responsive, knowledgeable, and health staff (doctors or nurses) and/or community
empathetic toward beneficiaries while members (community health workers, NGO staff, and
delivering nutrition messages. community leaders).

Topics of interpersonal trainings may include the following (HC3, 2016):
• Brief presentation of key formative research findings
• Overview of SBCC campaign, including channels, timeline, nutrition

activities, etc.
• SMART objectives underlying SBCC activities
• Role a as social influencers in SBCC activities- ”lead by example”
• Clearly-defined procedures to follow during fieldwork
• Technical content and rationale behind messages
• Expected questions and concerns that beneficiaries may have and

how to respond
• Feasible strategies to promote during interpersonal interactions at

the community level
• Being empathetic during interpersonal communications
Such a training with people who will implement interpersonal activities provides an opportunity
for trainers to also understand implementers’ perceptions toward nutrition.
Media
Implementer knowledge matters too

There are many forms of media, from social media to
print media. Therefore, trainings may be adapted, Too often we assume that only the
community members require behaviour
depending on the channels chosen to deliver
change, but it is also the case that the
messages. They may be technical in nature implementers have similar perceptions
(instructions for using SMS or Facebook to and behaviours as do the beneficiaries
communicate with beneficiaries) or logistical (where (Kurtz, 2016).
and how many posters to hang or how to work with

community radio partners to implement radio programs).
In some cases, messages may be delivered through plays or songs and the training should be
done by a communication agency or related partner agency. They may include training of radio
station staff members, for example voice actors who need to read scripts highlighting nutrition
behaviours and convey a certain tone, or actors in traditional theatre who need to perform
nutrition behaviours on stage. Trainings should be tailored to the medium chosen.
Social mobilization
Adequately training community members who will enact individual or collective behaviour
change through social mobilization activities is important for changing social norms. Appropriate
training helps to ensure that engagement with community members is done effectively, allowing
for trust building, and facilitating acceptance of nutrition messages.

Trainings should identify what existing community structures exist to build off already-
established trusted relationships. Utilizing existing structures, for example mother-to-mother
support groups and village development committees, may also help ensure better sustainability
of SBCC activities.
Prior to commencing social mobilization Spokesperson

trainings, it is important to use established and
A trusted point-of-reference within any
acceptable protocols to access communities. community where social mobilization
Doing so may require permissions from national, activities will be implemented. This person
may bridge the gap between community
sub-national and local government, as well as in
members and implementers, helping to
consultation with both elected and traditional communicate key issues.
community leaders. Following this process will
Mobilizer
help to identify the most appropriate
A highly-trusted community member who
spokespeople and mobilizers for existing
catalyses change. S/he works directly with
community structures (HC3, 2016). beneficiaries providing health messages,
encouragement, sensitization, and dialogue
Training planning matrices engagement around key health and nutrition
issues at all levels of community life.
A planning matrix is helpful for developing
appropriate training content, methods, resources and evaluation activities (USAID, 2013). Having
a well-planned training in line with your SMART objectives is necessary for sound SBCC
implementation.
An example of one matrix is filled out below as a reference, but complete training planning
should include a matrix for each SMART objective.
Table 10. Example of key categories to include in a training planning matrix
Training Similar to developing behavioural objectives, the training should have SMART
objective objectives too. Each objective should clearly describe what the training will achieve
by the end of the session.
Content Briefly explain what content will be covered for each training session. This content
may include not only the types of knowledge or skills that will be conveyed for
trainees, but also the types of information that will be solicited from participants to
understand their level of knowledge/skills.
Training The pedagogical approach should vary based on the type of information to be
methods covered. For sharing knowledge, didactic instruction may be appropriate. For skills-
based learning, you may consider role plays, group work, and demonstrations.
Using a combination of classroom and field-based learning is recommended prior
to implementation.

Resources Planning involves considering the resources and time needed to complete each
training session. Consider aspects such as a training venue, flip charts, markers,
writing utensils for participants, stationery, refreshments for participants, and
samples of specialized nutritious foods, for instance.
Evaluation Evaluating participant knowledge and skills will be important to understand

activities whether your training has been effective. Different teaching methods may benefit
from unique evaluation methods. Consider questions/answers at the group level,
observations of role plays, pre/post testing, one-on-one interviews.
Table 11. Training Planning Matrix Example – Interpersonal Communication Training
Session training objective: At the end of this session, trainees will demonstrate the
appropriate ability to use interpersonal communication to empathetically engage in
constructive dialogue around the importance of dietary diversity with caregivers.
Content/Tasks Training Methods Resources Evaluation Activities
• Oral presentation • Flip charts and • Question and answer

Teaching importance
with flip chart markers session with trainees to
of dietary diversity
• Time: 60 minutes measure
for nutrition
comprehension
• Oral presentation • Finalized SBCC flip • Question and answer

Reviewing
using SBCC flip charts session with trainees to
interpersonal
charts • Time: 90 minutes measure
materials with key
• Role play scenarios comprehension
dietary diversity
with different • Observation of a role
messages
partners play, use of
observational check list
• Oral presentation • Scripts for role • Question and answer
Emphasizing the need
• Role Play scenarios play session with trainees to
to be empathetic
(Trainees break into • Time: 60 minutes measure
during dialogue with
pairs and practise comprehension
caregivers
with various
scenarios)

Photo 11: Trainings should focus on both the ability of implementers to deliver technical
information as well as their capacity to be empathetic and understanding while doing so
Types of training
The training model selected will depend on the reach and intensity of the campaign. For a large-
scale SBCC programme, cascade training may need to be used (>60 implementing staff and
supervisors) (Kyabayinze et al., 2012). For regional or pilot scale programmes (<60 implementing
staff and supervisors), consider direct training of all staff.
The training approach will also vary by the level of implementer literacy so be sure to prepare
materials accordingly. Also, be sure to build in times for refresher trainings throughout the SBCC
programme lifecycle.
Table 12. Example of a simplified calendar with trainings by SBCC activity
Activity Group Jan Feb Mar Apr May Jun Jul
Direct Care Group Volunteers

interpersonal
training
Interpersonal Care Group Volunteers

activities
implementation
Interpersonal Re- Care Group Volunteers

training

Cascade Community Health
mobilization workers
training
Mobilization Community Health

activities workers
implementation
Mobilization Re- Community Health

training Workers
It is important to strategically linking key trainings to activities of the nutrition programme cycle.
Refresher trainings may be done quarterly or bi-annually depending on available resources and
planned programme activities. Refresher trainings should take place every few months at least,
depending on the SBCC programme activities.
Training content
Also, consider that refresher trainings

Refresher trainings offer an opportunity
are important for understanding
Provide an opportune time to get feedback from
challenges of implementation. Trainings
implementers about what is working well and what is
are not a one-way but a two-way not. A good portion of re-trainings should include
communication activity allowing for soliciting feedback from trainees about effectiveness
sharing of information between trainers of SBCC activities on the ground, not only training.
and trainees to improve SBCC activities.
A strong training is also tailored to the local settings and uses a combination of pedagogical
approaches best suited for each audience (Strasser and Neusy, 2014). You might consider
interactive role play during training sessions with interpersonal communicators, while didactic
instruction may be more heavily used when training the individuals responsible for distributing
media messages. People tend to learn the best from both listening and doing – that is, try to
make training an iterative process where both classroom and fieldwork time are built in as a way
to give trainees the chance to practise what they have learned prior to implementation (Kolb,
2014).

Step 6. Implement SBCC Campaign within WFP
Programme with Partners
At this stage, the implementation plan for the media spots and the interpersonal channels
should be finalized. Each person should know his/her roles and responsibilities for the successful
execution of the SBCC campaign, which should be fully planned before sensitization visits to
communities. Be ready to also share the implementation plan with relevant stakeholders.
An SBCC implementation manual should be developed as the guiding document aligning

stakeholders, and serving as the framework of implementation efforts. Consider having the
following functional components in an implementation manual:
SECTION 1. Background, Objectives, Guiding Policies
The lifecycle of nutrition programmes may span several years. In such a time period, staff
turnover is inevitable. Consequently, it is important that an implementation manual includes
sections that outline the background of the WFP-supported nutrition programme with SBCC
activities. It should also include a clear outline of the SBCC SMART objectives that were
developed based on the formative work. Guiding
Consider this background section a
theoretical (socio-ecological model) and nutrition
concise, yet important handover
document that will help orient new frameworks (national nutrition policies, global nutrition
staff when they join the programme. guidelines) serving as the underlying frameworks of
SBCC activities should also be explained in this
background section.
SECTION 2. Programme Impact Pathway (PIP)
Working with partners to articulate a PIP is necessary for implementation and monitoring efforts.
It will allow the WFP nutrition programme to
diagram how the SBCC activities are Programme Impact Pathway
planned in relation to the nutrition A description and mapping of intervention

interventions, as well as outline their activities, how they are implemented – from
delivery to impact – in relation to one another
pathways to expected outcomes.
and linked to immediate, intermediate, and final
Developing an accurate PIP should be an outcomes (Kim et al., 2011).
activity completed with partners through an
iterative process of stakeholder engagement.
The PIP represents activities important to programme implementation, as well as beneficiary

utilization.
Figure 13 is an example of a PIP from a community-based counselling intervention that was

implemented in Bangladesh by BRAC (Avula et al., 2013).

Figure 13. Example PIP from BRAC-led Nutrition Counselling Intervention in Bangladesh
Acronyms: HV, health volunteer; IYCF-P, infant and young child feeding promoter; PIP, programme impact
pathway
A PIP may take varying levels of complexity depending on the number of activities planned and
the pathways identified.
GANTT Chart
The PIP should also include a GANTT chart, a chart that serves as the calendar and timeline of
programme activities. It is a simple bar chart that illustrates the activities within a project
schedule. The GANTT chart provides the start and finish dates for all SBCC activities, allowing
project partners to better plan, implement, and monitor activities in alignment. Below is an
example of a simple, GANTT chart produced using Microsoft Excel.
Figure 14. Example of GANTT chart for planning SBCC activities

Several free GANTT chart templates are available on this website (Template Lab, 2017).
Partnerships
Partnerships are critical for WFP to carry out SBCC successfully. It is important to work with WFP
partners, including governments, other UN agencies, non-governmental organizations,
academia, community organizations, among others, throughout the entire SBCC process. Prior to
SBCC programming, you should identify which partners have the expertise and interest to
support your programme objectives. It is also helpful to identify which partner organizations are
conducting other SBCC activities in the area, to avoid duplicating efforts and identify potential
opportunities for collaboration. During SBCC implementation, having regular meetings with
partners will help ensure that everyone is informed, in agreement, and coordinated.
Implementation Structures
As part of organizing partnerships, it is useful to make a diagram of the SBCC implementation

structure. The diagram may outline partner roles, as well as management of activities within
existing national and sub-national organograms. This will help outline hierarchies and
relationships among personnel at each organizational level. Understanding local structures is
also a good way to ensure that implementation activities build upon and strengthen them, as
well as help to avoid any disruption of existing health and nutrition structures. The example
below highlights the implementation structure from a stunting prevention programme that
included SBCC activities in Malawi.

Figure 15. Implementation structure where SBCC activities were implemented in Malawi
Cabinet Committee on Social Development
OVERSIGHT
Parliamentary Committee on Nutrition, HIV and AIDS
Principal Secretaries Committee on Nutrition, HIV and AIDS
Multisectorial
Development Technical Nutrition
POLICY/ TECHNICAL
Partners Committee (5 TWGs)

COORDINATION
(Bilateral and
Multilateral Dept. of Nutrition, HIV and
Donors) AIDS (Local Gov’t, Health, Agric,
Gender, Education)
Academic &
Private Sector
Research
Sectors Institutions
(Local Gov’t, Health, Civil Society
Agric, Gender, Educ) Organisations
District Councils
(District Executive Committee & Full Council)
Area Development Council Committee District Nutrition

Committee Coordinating Committee
OPERATIONAL
Area Community Leaders

Action on Nutrition Area Nutrition Coordinating
Village Development Committee
Committee
Community Leaders
Action on Nutrition Village Nutrition
Coordinating Committee
Care Group Promoter

(2-3 Care groups)
Care Groups (8-12 Household Cluster Leaders)
Maternal and Child Nutrition, WASH, early stimulation, Good parenting, Bio-fortifies crops, Rearing of small
livestock, Village Saving and Loans, Community Growth Monitoring
Agreeing on an implementation structure with partners prior to implementation will help to

avoid interagency discordance throughout the programme cycle. The programme-specific
structure may include should not only individual roles and responsibilities in relation to one
another, but also organizational relationships involved in SBCC activity oversight, coordination
and operations.
Stakeholder Engagement
Community engagement should be prioritized in an SBCC implementation plan, as involving

communities enables them to ‘drive’ the nutrition-related behaviour change in their
communities in ways that are the most relevant and appropriate for them. Community
engagement also supports sustainability of the SBCC activities, so that communities are
supportive, invested, and be able to continue SBCC activities once the WFP intervention ends
(when possible). Community engagement includes stakeholder engagement, which should be
done early and frequently for alignment, dissemination and knowledge sharing between
community members and other key stakeholders. This aspect of SBCC was described in detail in

Chapter 5, but it should be included in an implementation manual as it should continue from the
formative phase through to the programming phase of the SBCC cycle.
SBCC Activities
In this section of an implementation manual, clear descriptions of SBCC activities should be

described and linked to individual creative briefs that outline minimum standards of
implementation (e.g. frequency of distribution, number of radio spots). It should offer narratives
that help explain where, when, and how the messages will be delivered through channels in
relation to WFP nutrition programme activities.
While creative briefs will provide a lot of this content, the implementation manual should more
clearly articulate how activities will be implemented with context-specific explanations. They
should also provide diagrams that help illustrate key points of contact at different behavioural
levels.
During a staff turnover, there should be no confusion about how the SBCC programming should
proceed. Therefore, this section of the manual should include relevant figures as well as
interpersonal, media, and social mobilization activities with very clearly-articulated steps of
implementation that even someone new to the program should be able to follow.
An example of steps for social mobilization taken from an SBCC implementation plan during a
stunting prevention programme in Malawi is provided below.
Table 13. Example of mobilization actions prior to and during the harvest season in a prevention
of stunting prevention programme in Malawi (Kodish, 2013)
Steps Dates Mobilization Action
• Cooperating Partner (CP)/ District Health Office (DHO) to conduct 1-

1 month prior to
harvest season 2 hour sensitization session with extension workers, including
Step 1
(approximately representation from health centre (e.g. medical assistant) about
March 01) season-specific communications strategies during harvest season*
• CP/ DHO to conduct full-day training with district-wide Health

3 weeks prior to Surveillance Assistants (HSA) on specific SBCC strategies during the
harvest season harvest season; to address questions and concerns about the
Step 2
(approximately programme; to retrain on key aspects of the programme including
March 07) messaging and Malawi’s Nutrition Education and Communication
Strategy
2-3 weeks prior • HSAs to conduct full-day training with the respective Care Group
to harvest Leaders in each Traditional Authority on season-specific
Step 3 season considerations around SBCC
(approximately
March 07- 4)

• Care Group Leaders facilitate care groups around SBCC
immediately prior to and during the harvest season with support
0-2 weeks prior
to harvest from the HSAs
Step 4 season
(approximately • Village headmen sensitize their villages on new messages and
March 15-30) challenges for the upcoming season. Also, village headmen to ask
for beneficiary promises during this time
• Beneficiaries receive SBCC at different levels and contact points
Harvest season throughout the harvest season via interpersonal, community, and
Step 5
(April–June)
district-levels of influence**
*The extension workers should be sensitized on SBCC around the harvest season as part of this programme, but not
be as exhaustively trained as the HSAs (who are central to this project). The sensitization is necessary to allow for a
multi-sectoral approach. **Traditional authorities, group village headmen, and village headmen should also be
sensitized on new SBCC activities through community meetings, as appropriate, leading up to the harvest season
The purpose of the chart above is to

Implementation Manual
demonstrate the level of detail needed to
Consider the implementation manual a ‘how-to’ allow for clear interpretation by
guidance document, with the level of detail
implementing partners. WFP Nutrition
necessary to ensure alignment among all
stakeholders for all SBCC activities planned Division has a detailed example of an SBCC
throughout the nutrition programme cycle. implementation manual, which is available
by request.
Budgeting
Costing the planned SBCC activities prior to implementation and keeping track of costs
throughout implementation should be done, just as it is for other WFP nutrition programmes.
Examples of SBCC-related budgeting can be provided by OSN upon request. Ensuring
Programme Quality
Developing Standard Operating Procedures (SOP) will be helpful during programme

implementation. The SOP will help to guide field activities and ensure standardization across
different localities. It will allow supervisors at any level to be aligned on programme objectives,
logistics, roles and responsibilities, behavioural steps required for implementers, and desired
outputs agreed upon by stakeholders, etc. Examples of SBCC-related SOP are also available from
OSN upon request.
Chapter 8, discussed later in this guidance manual, provides standards of SBCC implementation,
which are another means to help ensure SBCC programme quality. Additional topics may be
necessary to include as part of implementation planning, depending on the context of your WFP
nutrition programme.

Quality Standards - Programming Phase
This checklist is a tool to support WFP staff throughout the Programming phase. The
phase, whether alone as WFP or with partners and consultants, prior to progressing to
the next Monitoring/Evaluation phase.
Yes/No Step 5. Train staff for effective Comments

implementation of SBCC campaign
Training was planned using the matrix

provided for each SBCC objective
Varied training approaches were used
for different groups of implementers
and unique communications channels
Training plan includes key times for re-
trainings during the life of the
programme cycle
Trainings include activities to gather
feedback on training effectiveness and
to evaluate trainees
For social mobilization trainings, both
spokespersons and mobilizers are
included
Yes/No Step 6. Implement SBCC campaign Comments
within WFP programme with
partners
A detailed implementation manual is

guiding SBCC programme activities
SBCC activities are implemented in line
with the Programme Impact Pathway
Programming Phase
(PIP)
SBCC timelines of key activities are
outlined in line with nutrition
programme activities in a GANTT chart
An implementation structure agreed
upon with partners prior to
implementation
Implementation of all SBCC activities are
described in detail (frequency, points of
contact, etc.): as appropriate
A budget is being followed during SBCC
development and implementation
Standard Operating Procedures guide
SBCC field activities, ensuring
standardization across sites

References
Avula, R., et al. (2013). A Program Impact Pathway Analysis Identifies Critical Steps in the
Implementation and Utilization of a Behavior Change Communication Intervention Promoting
Infant and Child Feeding Practices in Bangladesh. The Journal of Nutrition. 143 (12): 2029-2037.
Health Communication Capacity Collaborative [HC3]. (2013). The P Process. Five steps to
strategic communication. Baltimore: Johns Hopkins Bloomberg School of Public Health Center
for Communication Programs.
Health Communication Capacity Collaborative [HC3]. (2014). Gender transformative

approaches: a HC3 research primer. Baltimore: Johns Hopkins Bloomberg School of Public
Health Center for Communication Programs. Available at
http://www.healthcommcapacity.org/wp-content/uploads/2014/08/Gender-Transformative-
Approaches-An-HC3-Research-Primer.pdf
Kim, S.S., et al. (2011). How do programs work to improve child nutrition? Program impact
pathways of three nongovernmental organization intervention projects in the Peruvian
highlands. International Food Policy Research Institute Discussion Paper 01105. IFPRI.
Kodish, S. (2013). Social and Behavioural Change Communication Strategy: Ntchisi, Malawi. Report
developed for the World Food Programme.
Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and development. FT
press.
Kurtz, E. (2016). Factors Impacting the Effectiveness of Health Care Worker Behavior Change: A
Literature Review.
Kyabayinze, D. J., Asiimwe, C., Nakanjako, D., Nabakooza, J., Bajabaite, M., Strachan, C., ...
& Van Geetruyden, J. P. (2012). Programme level implementation of malaria rapid diagnostic
tests (RDTs) use: outcomes and cost of training health workers at lower level health care facilities
in Uganda. BMC Public Health, 12(1), 291.
Strasser, R., & Neusy, A. J. (2010). Context counts: training health workers in and for rural and
remote areas. Bulletin of the World Health Organization, 88(10), 777-782.
Template Lab. (2017). 36 Free Gantt Chart Templates (Excel, PowerPoint, Word). Available at
http://templatelab.com/
USAID. (2013). Social and behavioural change communications: training for information,
education, and communication (IEC) officers, a facilitator’s guide. Developed for Ministry of
Health India. Available at http://pdf.usaid.gov/pdf_docs/PA00K6VP.pdf

Chapter 8. Monitoring Phase
Purpose:
The purpose of this chapter is to describe the final steps in the SBCC cycle. Step 7 includes
monitoring of SBCC programme activities and Step 8 focuses on programme improvement
based on findings from programme monitoring. While SBCC-related monitoring considerations
will vary across WFP programmes, this chapter aims to introduce methods and indicators that
may be adapted to different contexts.
• List examples of methods and indicators to inform SBCC programme quality

• Explain aspects of SBCC that may be modified based on monitoring findings
• Understand the basics of SBCC monitoring and evaluation methods
• Know what WFP Nutrition Division resources exist for SBCC monitoring
Photo 12: Using community-based participatory approaches during monitoring and evaluation
of SBCC can provide important information for improving programmes

Overview – Monitoring Phase
Monitoring is a fundamental aspect of WFP nutrition programmes. This phase seeks to outline
feasible indicators and methods for monitoring SBCC activities with WFP programmes. While
Step 7 focuses on monitoring efforts, Step 8 discusses the incorporation of findings into
programming for improvement of activities.
Globally, there is still considerable room for improvement related to the development of valid
and reliable indicators to monitor nutrition-related behaviour change programming. While this
chapter will provide suggestions for monitoring SBCC across interpersonal, media, and social
mobilization activities, there is room for testing both new indicators and innovative
measurement methods.
Figure 16. SBCC development process, Monitoring Phase

Formative
Phase
Development
Phase

Programming
Phase

Monitoring
Phase

Step 7. Monitoring the SBCC campaign to identify areas
for improvement
The monitoring phase is an important aspect of the SBCC development process. It aims to
assess whether SBCC activities are being implemented as planned and to what extent it is
meeting its social and behavioural objectives.
Programme Logic and Monitoring & Evaluation Framework
The WFP nutrition programme incorporating SBCC activities should have been developed
thoughtfully using a Theory of Change, including articulation of all programme activities and
their pathways to nutrition outcomes (Spahn, 2010). At minimum, the programme should be
based on an underlying Logic Model or even a more comprehensive PIP, which offers a visual
description of the logical flow of activities contributing to SMART programme objectives.
Comprehensive WFP Nutrition M&E guidance is available in the WFP Nutrition Monitoring and
Evaluation document, as well as in the WFP Standard Operating Procedures for Project
Monitoring and Evaluation. This chapter provides guidance specifically around monitoring and
evaluation of SBCC activities.
Steps for developing an M&E plan
STEP 1. Revisit the SMART SBCC objectives
The formative phase discussed the importance of developing SMART SBCC objectives, which not
only drive implementation activities but also measurement activities. These SMART objectives
will serve as the basis for M&E efforts.
Consider the following SMART objective related to improved knowledge from Chapter 5:
Knowledge-related SMART objective:
In 6 months, 75% of caregivers enrolled in the programme will be able to recall 3 key IYCF
messages from the SBCC campaign.
Monitoring considerations will thus need to consider when (e.g. after 6 months) and how (e.g.
knowledge question via in-person survey) this objective will most reliably and appropriately be
assessed. The SMART objectives outlined in the formative phase will drive efforts in this
monitoring phase.

STEP 2. Define SBCC indicators
IndiKit
Indicators to monitor and evaluate SBCC activities
A recently-launched website includes a
should cover the different domains that were
range of available indicators that can be
outlined as SMART SBCC objectives in table 4 considered for use in nutrition and SBCC
from Chapter 5. activities. Review” the Behaviour Change
section
Programme implementation
The first area may be related to programme implementation, which monitoring should
continuously assess through regular collection of data to assist in timely decision-making and
programmatic changes when necessary. Remember that the creative briefs outline minimum
standards of implementation that SBCC programming should adhere to while delivering SBCC
activities. Suggested SBCC-related indicators of programme implementation are outlined below.
Table 14. SBCC-related programme implementation indicators
Domains Description* Example of SBCC indicator by domain

• Interpersonal: households visited by Care Groups /
Dose Numerical amount of
household visits by Care Groups planned
delivered SBCC activities delivered
• Media: radio spots aired / radio spots planned
• Social Mobilization: district nutrition fairs

implemented / district nutrition fairs planned
• Interpersonal: households who received messages from

Reach Number of
Care Groups / total beneficiary households
beneficiaries exposed
to SBCC activities
• Media: beneficiaries who heard radio messages / total
beneficiaries in radio area
• Social Mobilization: beneficiaries who attended nutrition

fair / beneficiaries living in district
• Interpersonal: Care Groups trained / Care groups needed

Fidelity How well SBCC activities
for implementation
are implemented
based on those
• Media: proportion of radio spots airing at the correct
planned
times of day as planned
• Social Mobilization: proportion of brochures distributed

during nutrition fair / total number of brochures
*Descriptions adapted from Wilson, et al., 2009

While dose and reach are primarily collected through survey data, programme fidelity can be
assessed through both quantitative and qualitative information gained from secondary
programme records reviews, beneficiary interviews, and discussions with community leaders
(Saunders et al., 2005).
Before the uptake of a specific behaviour or set of behaviours is lower than desired, a sound
monitoring system should be able to detect problems and adjust for them based on the three
components outlined above: dose, reach, and fidelity. However, sometimes, even with close
monitoring, a programme may not be achieving its desired results.
Psychosocial outcomes
At the individual level, behaviour is largely

Psychosocial outcome
determined by a person’s intention to carry out
SBCC aims to influence behaviour through
that behaviour (Oulette and Wood, 1998). This
psychosocial constructs of an individual. Measuring
behavioural intention is influenced by other psychosocial constructs, such as someone’s
factors, though, including knowledge, self- intention to carry out a behaviour, can be an
efficacy, attitudes, and subjective norms, just to effective way to show SBCC programme impact
even if behaviours do not change as desired due to
name a few. other factors.
Psychosocial outcomes are quite important

because SBCC may positively influence an individual person’s motivation, intention, and attitudes
to perform a behaviour and thus show programme impact, even if other structural barriers (e.g.
far distance to nutrition clinic, cost of food, access to clean water) do not allow for the desired
behaviour change.
Examples of important psychosocial domains to consider for assessment through SBCC

programming are described below.
Table 15. SBCC-related Psychosocial Indicators
Domains Descriptions (Adopted from NCI, Examples of SBCC indicators

2005)
Knowledge Facts, information, and skills Proportion of pregnant women able to recall 3
necessary to perform a behaviour iron-rich, locally-available foods
Intention Perceived likelihood of performing Proportion of school-aged children intending to

a behaviour avoid sugary drinks this entire week
Self-efficacy Confidence in one’s ability to take Proportion of caregivers who feel confident that
action and successfully carry out they can provide ready-to-use food only to their
the behaviour child every day this week without sharing

Attitude Perceived evaluation and / or Proportion of grandmothers who support their
enthusiasm toward the behaviour daughter-in-law to exclusively breastfeed with no
water or other liquids until 6 months
Subjective Perception about whether key Proportion of male caregivers who believe their
norm people approve or disapprove of community leader supports them in promoting
the behaviour healthy IYCF practices
Perceived Belief that one has, and can Proportion of adolescent girls who believe they
behavioural successfully exercise, control over can consume animal-source protein each day
control performing the behaviour this week
There are a number of additional psychosocial constructs that can be measured through
surveys. Should the indicators listed in the table above not seem feasible or appropriate for the
context in which your SBCC activities are being implemented, consult with Regional Bureaux and
OSN for additional guidance.
Behavioural Outcomes
SBCC activities aim to improve nutrition-related behaviours. Therefore, SBCC interventions

should include a robust M&E plan to assess behavioural outcomes. There are a few different
ways to capture nutrition behaviours, which are notoriously difficult to evaluate reliably
(Westerterp and Goris, 2002). This is because what people say and what people do can often be
at odds with each other.
Table 16. Methods for Evaluating Nutrition Behaviours
Domains Description Examples of SBCC indicators
• Complementary feeding: Proportion of

Self-reported Beneficiary recall of their
caregivers reporting adding leafy green
behaviours own nutrition-related
vegetables to child’s porridge in past 24 hours
behaviours through
questionnaires/surveys
• MNP adherence: Proportion of caregivers
reporting appropriate usage of MNP to fortify
child’s porridge
Observed Direct observations of
meals directly observed where green leafy
behaviours beneficiary nutrition-
vegetables were added to child’s porridge
related behaviours through
observations, checklists,
• MNP adherence: Proportion of meals
spot checks*
observed where MNP was appropriately
utilized to fortify a child’s porridge
Shadowed data Using indirect, or non-
porridge leftovers that have remnants of leafy,
observed, evidence to
green vegetables
roughly gauge behaviours
of interest

• MNP adherence: Number of empty MNP
sachets in household / Total number of MNP
sachets available in household
*Spot checks are unannounced observations typically at the household or clinic level to understand a behaviour
of interest (Ruel and Arimond, 2002)
Using at least two of these methodological approaches is

Methodological triangulation
recommended to triangulate findings and get a better
Findings from self-report may be
sense of SBCC impacts on behaviours. Using data to
different from findings from
draw from different methodological approaches will help observational data. What people
say and what people do are often
understand the SBCC behavioural impacts from different
quite different things when it comes
angles, and thus better inform programming. to nutrition (Abbeddou et al, 2015).
The nature of the SMART objectives, resources available,

and context of the programme will determine what combination of behavioural assessment
methods is most feasible and relevant (Mertens, 2014).
STEP 3. Define Methods of Measurement
SBCC activities should be assessed using both quantitative and qualitative methods. A mixed-
methods approach will provide a more complete story about the effectiveness of the SBCC
campaign.
Qualitative measurement
Throughout the nutrition programme lifecycle, it is important to understand how activities are
being implemented according to plan. Some questions related to programme fidelity, which
measures how well the programme was implemented, include:
• How can key messages be modified to better resonate with target

population?
• To what extent are the current channels appropriate for the intended
audience segments?
• How are the community members perceiving the SBCC activities?
• What challenges are implementers facing while delivering messages?
• What SBCC activities are working particularly well and why?
• What are the continual barriers that are impede the desired behavioural
outcomes?

While quantitative data can outline the “what” or “how many”, qualitative data can help to explain
the “why” or “how” behind behaviours of interest. By using qualitative methods, such as
conducting in-depth interviews with beneficiaries and
community leaders, holding focus group discussions with Process Evaluation for SBCC
Activities
programme staff or community members, and using
household observations to see first-hand the barriers to Understanding what works well is just
as powerful as understanding what is
nutrition-related behaviours of interest, the
not working well.
implementing team can understand why the programme
is or is not achieving desired results. Qualitative evaluation methods are critical to understand
why or why the program is or is not working.
Photo 13: Semi-structured interview to inform programming in Bangladesh
Regular qualitative assessments of the programme activities will help to elucidate the main
barriers and facilitating factors to the key behaviours of interest. Ideally, this work should be
conducted by a third-party consultant who has no stake in the programme, for ethical
considerations, and they can bring a different lens to understanding the programme. Having a
clear understanding of the barriers to social and behavioural change in the context of SBCC
programming is critical to making informed decisions around rejuvenation efforts.
Quantitative measurement
Collecting indicators through quantitative methods is important for quantifying key indicators of
interest. Such information can be collected through in-person questionnaires, large-scale
surveys, SMS surveys, and household observations, just to name a few. Questions related to
psychosocial constructs and self-reported behaviours can be embedded into routine monitoring
surveys, as well as included in before/after programme evaluations.

Survey development may take a variety of forms with different types of question formats
depending on the programme type, type of information desired, audience literacy, resources
available, etc.
Table 17. Type of quantitative survey questions and their descriptions
Survey question types Description Example
Multiple-choice Question offering multiple Knowledge question: Which of the

options where only one answer is following foods is iron rich?
typically correct A. Maize
B. Orange
C. Chicken liver
D. Sorghum
Free answer Open-ended question that allows Knowledge question: Please name 2 key
for a free response, provides no strategies that you learned from the radio
answer choices show to help prevent diabetes.
True/False Question where only two options Knowledge question: Oranges are a rich
(true or false) are presented source of vitamin C.
based on a statement
True or False?
Likert* Questions based on a scale and Self-efficacy question: On a scale of 1 – 5

useful for assessing non- how confident are you that you can add the
dichotomous variables. lipid-based nutrient supplement (LNS) to
your child’s porridge every day this week
without sharing it among household
members?
1. Not confident at all
2. Unconfident
3. Unsure
4. Somewhat confident
5. Very confident
*Likert-like questions are particularly useful for assessing psychosocial constructs since attitudes, self-efficacy, etc. are
typically not dichotomous; they are usually on a continuum and make Likert-like questions suitable. Such questions, in
particular, require pilot testing as they may not be familiar to WFP beneficiaries.
Determining the most appropriate methods and instruments for collecting qualitative and
quantitative data to collect to monitor and evaluate SBCC programs, and which indicators to use
requires careful planning. Appropriate monitoring and evaluation also requires detailed training
of enumerators on data collection, monitoring and evaluation (Agrawal et al., 2014). Regional
Bureaux and OSN can provide more detailed guidance as needed.
STEP 4. Data analysis
Once data are collected, then they have to be cleaned and analysed. The level of analysis will
depend on the capacity and resources available to the WFP programme. Each programme will
have its own circumstances and need to adapt accordingly. There is no point in collecting a vast

number of indicators through rigorous methods if the programme does not have the capacity to
analyse and synthesize findings. The WFP Nutrition Division can provide analytic guidance
related to SBCC data analysis as needed upon request.

Step 8. Improve SBCC strategy based on monitoring
efforts
This chapter is dedicated to providing an overview of necessary steps to take for improving SBCC
activities based on monitoring data. Throughout the course of an SBCC programme, the strategy
may become stale and less effective for myriad reasons, some related to the strategy or
programme itself (e.g. radio becomes too expensive to utilize), others related to an unanticipated
environmental change in the intervention district (e.g. changing population dynamics).
Consider taking the following steps to steer direction of the intervention in case of suboptimal
results.
Step 1. Synthesize
programme monitoring
findings
Step 3. Implement Step 2. Decide a course

action of action
STEP 1. Synthesize programme monitoring findings
Before adjusting the SBCC activity plan, it is important that findings from the qualitative and
quantitative monitoring be analysed, synthesized, and disseminated among stakeholders.
Ensuring alignment on what is working well and what is not working well will be important to
guide agreed-upon programmatic adjustments.
It will be useful to use the stakeholder meetings to help build consensus around priority areas
for adjustment, as well as use them to help clarify any findings that seem unusual, contradictory,
or need clarification.
STEP 2: Decide an improved course of action
After stakeholder alignment on the programmatic challenges and facilitating factors for SBCC,
the best courses of action can be determined. SBCC activities can typically be modified in a few
different ways, from minor tweaks to major restructuring.

Below is a list of potential ways to modify SBCC activities from less disruptive (i.e. minimal
modification to the current strategy) to more disruptive (i.e. more pronounced modification).
 Adjusting SMART objectives
You may determine with stakeholders that the initial SMART objectives for the SBCC campaign
were too ambitious, inappropriate, or too limited. Should monitoring data indicate that the
programme can be improved through improvements to the initial SMART objectives, then they
should be modified first and foremost. It is the SMART objectives that drive SBCC activities,
including choices of messages and channels. Therefore, reconsider SMART objectives as you
assess monitoring data and look for areas to improve the SBCC activities.
 Modifying Messages
Messaging content: Key messages should

Lessons Learned from Ebola Outbreak
be context- and audience-segment
specific. While messages should be Inappropriate health messaging contributed to
increased anxiety and a breakdown in trust
partially based on formative research
between the health workers and community
findings to resonate with audience members during the West Africa Ebola outbreak in
segments, it is possible that for some 2014. Changes in messaging, through further pilot
testing with communities, eventually helped to
reason they do not resonate as
improve health-seeking behaviours (Kinsman et
anticipated. At worst, it is possible that al., 2017).
some messages are offensive among
certain audience segments despite pilot testing.
Messaging frequency: The frequency of key messages delivered could be enhanced or reduced
in case monitoring data suggest that the dose is inappropriate. If too many messages are being
delivered at any given time, then it is possible that no messages will resonate with community
members.
In such a case, consider staggering message delivery by season or in line with nutrition
programming. Heightening the messaging, either through increased message frequency or
additional channels, will require additional funding so budgeting considerations will be an
important piece to this option.
Language of messaging: Also, the language

Modifying messaging, may be one option
used within messages could be tweaked in the
to improve SBCC activity implementation
case data indicate that important terms are not
clearly understood by intended audience segments. For instance, local dialects may not be
captured during formative research and pilot testing.

 Varying Channels
The SBCC strategy should be designed to incorporate a variety of communication channels.

Monitoring data may indicate that some channels reach more intended beneficiaries than
others, or other channels are too expensive for programming.
Modifying channel usage: Another way to improve the SBCC strategy is to modify the channels
used to deliver messages. While channels can be modified throughout the life of the
programme, it will be important that the strategy still adheres to a socio-cultural framework
impacting at individual, interpersonal, community and organizational levels.
It may also be that certain combinations of channels do not work due to a lack of available staff
and resources. Therefore, changing channel combinations at any given time may be an option
too.
 Rebranding
In the worst-case scenario, it is possible that behaviours are suboptimal in the programme
because the entire SBCC or nutrition campaign was rejected by the community. The SBCC
strategy should have utilized community inputs through the formative research in order to
develop the programme in a participatory manner, enhancing the likelihood of programme
acceptance and community ownership.
However, for any number of reasons, including negative

Rebranding may include a
rumour generation around any one aspect of the transformation of the campaign
programme, segments of the population may reject the logo, name, slogan, and/or creative
programme. If monitoring data indicate that behaviour design associated with SBCC
activities.
change is not occurring for such a reason, then a
rebranding should be considered.
A rebranding also should address the problems outlined in monitoring data very directly;
otherwise, the transformed programme may face the same challenges moving forward. Changes
should be meaningful, so beneficiaries notice and care, as well as powerful enough to make the
difference that community members and programme implementers desire.
STEP 3. Implement action
Whether it is a modification of SMART objectives, tweaks

With any change, communicate and
to messaging, or an entire rebranding, the rejuvenated
coordinate with stakeholders.
SBCC strategy can be implemented again with close
monitoring. It is this monitoring that will allow the programme to run smoothly and give
continuous information to programme staff about possible course correction.

Quality Standards - Monitoring Phase
Yes/No Step 7. Monitor SBCC campaign to Comments

identify areas for improvement
The M&E plan is based on a

Programme Impact Pathway (PIP)
and/or logic model
The M&E plan describes data sources
and a timeline for collecting data
Indicators are valid, reliable, specific,
sensitive, and operational, aligned with
the SMART objectives
Programme indicators of dose, reach,
and fidelity, etc. are assessed
A separate process evaluation is
planned during SBCC implementation
Psycho-social indicators of self-efficacy,

intention, attitudes, etc. are assessed
Behavioural indicators from self-report

and shadowed data, etc. are assessed
Mixed methods (quantitative and

qualitative methods) are used for data
collection during M&E activities
Yes/No Step 8. Improve SBCC strategy based Comments
on monitoring efforts
Changes to SBCC activities are evidence

informed, based on mixed methods
M&E data
Any SBCC changes still align with
Monitoring Phase
original or revised SMART objectives

Changes in channels, messages, etc.
are accompanied by changes in M&E
with new indicators
All stakeholders agree on any changes
to improve SBCC quality

References
Abbeddou, S., Hess, S. Y., Yakes Jimenez, E., Somé, J. W., Vosti, S. A., Guissou, R. M., ... &
Brown, K. H. (2015). Comparison of methods to assess adherence to small‐quantity lipid‐based
nutrient supplements (SQ‐LNS) and dispersible tablets among young Burkinabé children
participating in a community‐based intervention trial. Maternal & child nutrition, 11(S4), 90-104.
Indikit. (2017). Development and relief indicators for monitoring and evaluation. Available at
https://www.indikit.net/sector/21-nutrition
Kinsman, J., et al. (2017). Development of a set of community-informed Ebola messages for
Sierra Leone. PLOS Neglected Tropical Diseases. 11(8): e0005742.
Mertens, D. M. (2014). Research and evaluation in education and psychology: Integrating diversity
with quantitative, qualitative, and mixed methods. Sage publications.
National Cancer Institute [NCI]. (2005). Theory at a glance: A guide for Health Promotion Practice.
NY: National Institute of Health.
Ouellette, J. A., & Wood, W. (1998). Habit and intention in everyday life: The multiple processes
by which past behavior predicts future behavior. Psychological bulletin, 124(1), 54.
Ruel, M. T., & Arimond, M. (2002). Spot-check observational method for assessing hygiene
practices: review of experience and implications for programmes. Journal of Health, Population
and Nutrition, 65-76.
Spahn, J.M., et al. (2010). State of evidence regarding behaviour change theories and strategies
in Nutrition counseling to facilitate health and food behaviour change. Journal of the American
Dietetic Association. 110(6): 879- 891.
Saunders, R. P., Evans, M. H., & Joshi, P. (2005). Developing a process-evaluation plan for
assessing health promotion program implementation: a how-to guide. Health promotion practice,
6(2), 134-147.
Westerterp, K. R., & Goris, A. H. (2002). Validity of the assessment of dietary intake: problems
of misreporting. Current Opinion in Clinical Nutrition & Metabolic Care, 5(5), 489-493.
Wilson, D.K., et al. (2009). Using process evaluation for program improvement in dose, fidelity
and reach: the ACT trial experience. International Journal of Behavioural Nutrition and Physical
Activity. 6:79.

Chapter 9. Standards of SBCC Programming
Purpose:
The purpose of this chapter is to provide a checklist for WFP staff to use when designing,
implementing, and monitoring SBCC activities. This chapter offers suggested minimum standards
of implementation for WFP staff to use as they collaborate on SBCC-related programming or use
with consultants and partners.

• Understand how standards may be used in each step of the SBCC development cycle
• Apply and adapt these standards across WFP nutrition programs and contexts
Photo 14: Standards of SBCC implementation can help programmes ensure quality

Overview – Quality Standards
This checklist should serve as a performance tool to help track progress throughout each phase
of the SBCC development cycle. The performance standards may help WFP nutrition
programmes that are either directly implementing their own SBCC activities or those that have
sub-contracted partners to do so. The checklist may be modified depending on the type of
nutrition programme and the context in which the SBCC is being implemented.
SBCC Quality Standards
PHASE 1: Formative Phase Quality Standards

Yes/No Step 1. Conduct formative work to Comments
gather context-specific information
Formative work includes a desk review,

stakeholder engagement, and primary
data collection.
Mixed methods (both qualitative and
quantitative methods) are used during
primary data collection
Formative research is participatory in
nature, with community member
involvement
Lists of barriers and facilitating factors are
elucidated for each nutrition behaviour of
interest at each socio-ecological level
Formative work outlines key behaviours to
change, audience segment profiles,
preferred channels, salient words/phrases,
and other considerations
Monitoring and evaluation inputs are

suggested in formative findings
Yes/No Step 2. Develop SBCC strategy with Comments

well-defined SMART objectives
An SBCC strategy is articulated, with

channels, audience segments, and
messages outlined based on formative
work.
All objectives are Specific, Measurable,

Attainable, Relevant, and Time-based.
Formative Phase
The planning table with simple checklist

was used to develop each SMART objective
SMART objectives cover domains related

to programme performance, psychosocial
constructs, and behaviours

The SMART objectives are created based
upon the formative findings.
PHASE 2: Development Phase Quality Standards
Yes/No Step 3. Draft creative briefs from Comments

formative findings to develop SBCC
material
This phase is led by someone, or a
team, with experience in nutrition,
social and behaviour change, and
communications
A creative brief is completed for each
communication channel and based on
findings from the formative phase.
A justified combination of approaches
(interpersonal, media, and
mobilization) was chosen to reach
audience segments at different
behavioural levels
A unique set of tailored messages for
each audience segment are provided
Tailored messages are developed
based on the six-step process outlined
in step 3 of this guidance
All messages are technically accurate
from a health and nutrition perspective
Messages are context-appropriate for

the channels chosen and audience
segments (language, complexity, etc.)
Yes/No Step 4. Pre-test SBCC materials Comments

among target audience segments

beginning of this step to introduce
SBCC draft materials
Development Phase
Qualitative data collection using both

interviews and focus groups occurs
among key audience segments
Refinements and modifications are
made to the SBCC materials based on
feedback by stakeholders and
community members
end of this step to build consensus
around revised SBCC materials prior to
launch

PHASE 3: Quality Phase Quality Standards
Yes/No Step 5. Train staff for effective Comments

implementation of SBCC campaign
Training was planned using the matrix

provided for each SBCC objective
Varied training approaches are used for
different groups of implementers and
unique communications channels
Training plan also includes key times for
re-trainings during the life of the
programme cycle
Activities are included in the trainings to
receive feedback on training
effectiveness and to evaluate trainees
For social mobilization trainings, both
spokespersons and mobilizers are
included
Yes/No Step 6. Implement SBCC campaign Comments
within WFP programme with
partners
A detailed implementation manual is

guiding SBCC programme activities
SBCC activities are implemented in line

Programming Phase
with the Programme Impact Pathway

SBCC timelines of key activities are
outlined vis-à-vis the nutrition
programme activities in a GANTT chart
An implementation structure is agreed
upon with partners prior to
implementation
Implementation of all SBCC activities are
described in detail (frequency, points of
contact, etc.) as appropriate
A budget is being followed during SBCC
development and implementation
Standard Operating Procedures guide
SBCC field activities, ensuring
standardization across sites

PHASE 4: Monitoring Phase Quality Standards
Yes/No Step 7. Monitor SBCC campaign to Comments

identify areas for improvement
The M&E plan is based on a

Programme Impact Pathway (PIP)
and/or logic model
The M&E plan describes data sources
and a timeline for collecting data
Indicators are valid, reliable, specific,
sensitive, and operational, aligned with
the SMART objectives
Programme indicators of dose, reach,
and fidelity, etc. are assessed
A separate process evaluation is

planned during SBCC implementation
Psycho-social indicators of self-efficacy,

intention, attitudes, etc. are assessed
Behavioural indicators from self-report

and shadowed data, etc. are assessed
Mixed methods (quantitative and
qualitative methods) are used for data
collection during M&E activities
Yes/No Step 8. Improve SBCC strategy based Comments
on monitoring efforts
Changes to SBCC activities are evidence

informed, based on mixed methods
M&E data
Any SBCC changes still align with
original or revised SMART objectives
Changes in channels, messages, etc.
are accompanied by changes in M&E
Monitoring Phase
with new indicators
All stakeholders agree on any changes

to improve SBCC quality

Photo credits
Page 11, 14, 90: Shazam Noorani;
Page 21: Rein Skullerud;
Page 23: Alejandre Lean;
Page 27, 35, 76, 82: Stephen Kodish;
Page 31: Mike Bloem;
Page 35: Giulio d’Adamo and Ranak Martin;
Page 51, 61, 66: Malawi Country Office;
Page 46: James Giambrone;
Page 48: Dina El Kassaby;
World Food Programme

Via Cesare Giulio Viola 68/70 00148 Rome, Italy
T +39 06 65131 wfp.org


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Social and Behaviour Change

1 |Guidance Manual for WFPJanuary 2019

Nutrition Division (OSN)

Via Cesare Giulio Viola, 68

2 |Guidance Manual for WFP Nutrition

Tables and Figures .............................................................................................................................. 8

Chapter 1. What is SBCC? ................................................................................................................. 10

Chapter 2. SBCC Terminology .......................................................................................................... 15

Chapter 3. Theoretical Basis of Changing Nutrition Behaviours ................................................. 23

Chapter 4. SBCC in WFP Contexts.................................................................................................... 29

Chapter 5. Formative Phase ............................................................................................................ 35

3 |Guidance Manual for WFP Nutrition

Chapter 6. Development Phase ....................................................................................................... 56

Chapter 7. Programming Phase ...................................................................................................... 82

Chapter 8. Monitoring Phase ........................................................................................................... 98

Chapter 9. Standards of SBCC Programming ............................................................................... 113

4 |Guidance Manual for WFP Nutrition

This guidance manual introduces a systematic approach to developing culturally-appropriate SBCC

5 |Guidance Manual for WFP Nutrition

6 |Guidance Manual for WFP Nutrition

BCC Behaviour Change Communication

BSFP Blanket Supplementary Feeding Programmes

CBT Cash-Based Transfers

CMAM Community Management of Acute Malnutrition

IEC Information, Education and Communication

IYCF Infant and Young Child Feeding

LNS Lipid-based Nutrient Supplement

LMICs Low- and Middle-Income Countries

M&E Monitoring and Evaluation

MNP Micronutrient Powders

NGO Non-Governmental Organization

OSN Operation Services Nutrition

PHM Persuasive Health Messages

PIP Programme Impact Pathway

PLHIV/TB People Living with HIV/AIDS and/or Tuberculosis

RAP Rapid Assessment Procedures

RUTF Ready-to-use Therapeutic Food

SBCC Social and Behaviour Change Communication

SDG Sustainable Development Goal

SEM Socio-Ecological Model

SOP Standard Operating Procedures

TSFP Targeted Supplementary Feeding Programmes

WASH Water Sanitation and Hygiene

WFP World Food Programme

7 |Guidance Manual for WFP Nutrition

Table 1. Commonly-used SBCC approaches and activities ....................................................... 11

Table 2. Key SBCC terms and their descriptions ......................................................................... 13

Table 3. Examples of SBCC Entry Points in WFP Nutrition Programming ............................... 40

Table 4. Examples of formative research data collection methods ......................................... 45

Table 5. SMART behavioural objectives ........................................................................................ 45

Table 7. Domains to include in a creative brief to inform SBCC material ............................... 60

Table 8. Considerations of SBCC channels and their level of influence .................................. 62

Table 9. Context-specific considerations when deciding upon appropriate channels ......... 86

Table 11. Training planning matrix example – interpersonal communication training........ 88

Table 14. SBCC-related programme implementation indicators ........................................... 102

Table 15. SBCC-related psychosocial indicators ....................................................................... 103

Table 16. Methods for evaluating nutrition behaviours .......................................................... 106

Table 17. Type of quantitative survey questions and their description……………………………107

8 |Guidance Manual for WFP Nutrition