behaviour change, communication, health, strategy

Behaviour Change Campaigns: Iterating a Health Communication Intervention Using the WHO’s Itinerary


meta-analysis conducted by the British Medical Journal into the “complex and contentious” nature of health communication interventions revealed that, while difficult to incorporate into routine clinical practice, they can be made workable by “using existing…frameworks as the basis for [their] development.”


The World Health Organization produced the Strategic Communications Framework for effective communications – an operating manual designed to develop “effective, integrated and coordinated” health communication interventions “across a broad range of issues.”

The strength of this “framework of principles” lies in its generality: it was not designed for “particular diseases, specific health observances, or geographic regions.” Thus, it can be used for a variety of campaigns ranging from “chronic health issues to emerging and novel risks.”


The WHO Strategic Communications Framework for effective communications(“The Framework”) is structured around six principles, which every intervention must meet in order to be effective:

1.   Accessible

2.  Actionable

3.  Credible and Trusted

4.  Relevant

5.   Timely

6.  Understandable

These principles, designed to be tackled sequentially, are ordered as such to help campaigners “set priorities, select appropriate interventions, devise better means of delivery, improve management, and be more effective in mobilising resources.”


The principle of ‘Accessible’ encourages campaigners to “identify all channels [of distribution] that are available, and map their capacities to reach priority audiences.”

In order to “empower audiences with the information they need to make informed decisions,” campaigners must understand the three main channels:

1.   Mass media: television, radio, magazines, and website advertising.

2.  Organisation and community: community-based media (local newsletters, local radio), community-based activities (health fairs, picnics), community-based institutions (school, religious meetings).

3.  Interpersonal: family, friends, faith leaders, health care practitioners, teachers and counsellors of those seeking advice or sharing information about health risks.

When prioritising a channel, campaigners should consider the power of visual content. With its above-average engagement rate, images can motivate the audience “to seek more information and make issues resonate at a personal level.”


The principle of ‘Actionable’ encourages campaigners to understand “target audience knowledge, attitudes and behaviours in order to create messages that address barriers and encourage decision-markers to take the recommended steps.”

Providing answers to the following eight questions helps transform a campaign from a pile of information into an effective message that moves the audience towards accepting and acting on “advice, guidance, and recommendations.”

1.   What is the behaviour or action we want audiences to take to protect themselves or those they care about? Is there a behaviour or action that needs to be discouraged?

2.  Do the target audiences understand the situation, the health risks and recommended behaviours and policies?

3.  Do target audiences perceive the health issue as relevant to them; do they feel personally engaged with the issue?

4.  Do audiences understand the benefits of adopting the recommended behaviours or policies? Do they understand the consequences of not adopting them?

5.   What are the barriers preventing the adoption of health protection actions or policies?

6.  What social norms exist that could positively or negatively influence adopting the recommended action?

7.  How confident are decision-makers in their ability to endorse the safe and healthy behaviours, or to pass policies that promote health?

8.  Is the target audience able to act independently? If they need help in order to act, does the message describe what support might be available for them (either from the community or other stakeholders) or where to find additional information?


The principle of ‘Credible and Trusted’ encourages campaigners to approach their work in a reputable manner. By focusing on the following four strategies, campaigners can reinforce public trust by demonstrating:

1.   Competence: professional expertise in the health issue at stake, providing information that is consistent with other experts and trusted organisations.

2.  Openness: a dutiful transparency in the work and the organisation behind it, revealing what they know and what they don’t.

3.  Dependability: a reputation for doing what you say you’ll do.

4.  Caring: a commitment to fulfilling the message by supporting the audience to which it is targeted.


The principle of ‘Relevant’ encourages campaigners to tailor communications specifically for the target demographic so the audience “see[s] the health information, advice or guidance as applicable to them, their families, or others they care about.”

To ensure public health issues are seen as relevant to the audience, campaigners must answer the following six questions:

1.   What socio-demographic characteristics of the audience (such as age, education, geographic location) can inform message design and dissemination plans?

2.  Do individuals perceive they are at risk of the health threat? Does that perception correspond to the actual degree of the risk? Some individuals experience greater concern than is appropriate.

3.  Does the audience have experiences with similar health risks, which can be referenced to develop messages about the current issue?

4.  Does the audience feel there are steps they can take to reduce the risks to their health?

5.   What is the audience hearing about the health issue from other sources that may affect their understanding of the message?

6.  What personal, community or national values related to the health topic could be associated with the need to act on the messages and materials?


The principle of ‘Timely’ encourages campaigners to make information available in a “timely way, so audiences have the information they need when they need it to make appropriate health decisions.”

Campaigners must answer the following five questions when designing communications to ensure they are timely:

1.   When health threats are urgent, what are the best methods to engage priority audiences quickly?

2.  When are the audiences likely to be faced with a health-related decision for themselves or others on the health topic?

3.  How can messages be delivered so that audiences have enough time to understand and act on the message?

4.  Are there times when a health message will be crowded out by competing issues and concerns?

5.   Is there a way to deliver a sequence of messages over time that would increase the effectiveness of information and advice?


The principle of ‘Understandable’ encourages campaigners not to rely on technical information to relay their message given how key audiences “need information that is easy to understand in order to comprehend health risks and take appropriate actions.”

To help ensure messages are understandable, campaigners must answer these six questions:

1.   How familiar is your audience with the topic? Does the audience have prior experience with the specific health threat or does your communications need to provide basic information to create awareness?

2.  What is your most important message, that is, what do you want your audience to do? How can you highlight it?

3.  Does your message clearly state the action you want the audience to take?

4.  Can you use photos or illustrations that provide visual reinforcement of the main messages?

5.   Are you using language that is familiar to the target audience?

6.  Have you, or can you, test your messages with audience members to ensure the meaning is clear?

Providing visual reinforcement is particularly vital because visual messages make information “easier to understand and can reach people of all literacy and education levels.”


The WHO Strategic Communications Framework for effective communicationsprovides a holistic structure that enables campaigners to incorporate their intervention efforts into routine clinical practice.

Designed to reflect vulnerable demographics as humans that are members of a social community, the framework can empower campaigners to deliver health communications that “increase the intended audience’s knowledge and awareness of a health issue, problem, or solution … prompt action … show the benefit of behaviour change … and increase demand or support for health services.”

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