STS: General Concepts in ACSM

What is A in ACSM

Content

In ACSM, "A" stands for Advocacy. "Advocacy" is an activity by an individual or a group that aims to influence the decisions within political, economic and social institutions.

Advocacy focuses on influencing policy-makers, funders and international decision-making bodies through a variety of channels:

Conferences, summits and symposia
Celebrity spokespeople, press conferences, news coverage
Meetings between various levels of government and civil society organizations
Official Memoranda of Understanding (MoU), parliamentary debates and other political events
Partnership meetings, patients’ organizations, private physicians, radio and television talk shows, and service providers.

Types of advocacy

Policy advocacy: Mainly targets policy-setting, influencing policymakers to incorporate the latest evidence and informs senior politicians and administrators how an issue will affect the country, and outlines actions to take for improving the laws and policies.
Programme advocacy: Targets opinion leaders at the community level on the need for local action.
Media advocacy: Validates the relevance of a subject, puts issues on the public agenda and encourages the media to cover TB-related topics regularly and in a responsible manner so as to raise awareness of possible solutions and problems.

Resources

Assessment:

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News reports on World TB day celebrations are an example of which of the following types of advocacy?

Policy advocacy

Programme advocacy

Media advocacy

None of the above

3

Media advocacy encourages the media to cover TB-related topics regularly and in a responsible manner so as to raise awareness of possible solutions and problems.

Yes

What is C in ACSM

Content

Communication aims to favourably change knowledge, attitudes and practices among various groups of people.

Types of communication in healthcare are:

Oral/verbal communication- by word of mouth (speech/talk)
Written communication- exchange of facts, ideas and opinions through the use of written materials
Non verbal communication- through gestures, body language or posture, facial expressions, and eye contact
Visual communication- exchange of ideas through visuals

Health communication aims to influence and empower individuals, populations and communities to make healthier choices. It frequently informs the public of the services that exist for diagnosis and treatment and relays a series of messages about the disease. It aims to inculcate behaviour change for healthy life choices.

E.g.: “Seek treatment if you have a cough for more than two weeks”, “TB hurts your lungs” or “TB is curable”.

Approaches to health communication

1. Informative communication

Provides information about a new idea and makes it familiar to people.

2.Educative communication

A new idea on health behaviour is explained, including its strengths and weaknesses.

3.Persuasive communication

Usually in the form of a message that promotes a positive change in behaviour and attitudes, and which encourages that audience to accept the new idea. This approach to message development involves finding out what most appeals to a particular audience. Persuasive approaches are more effective than coercive approaches in achieving behaviour change.

4.Prompting communication

Messages are designed so that they are not easily ignored or forgotten they can be used to remind the audience about something that reinforces earlier messages.

Behaviour Change Communication (BCC)

Behaviour Change Communication (BCC) is an interactive process of any intervention with individuals, groups or communities to develop communication strategies to promote positive health behaviours which are appropriate to the current social conditions and thereby help the society to solve their pressing health problems.
BCC creates an environment through which the affected communities can discuss, debate, organize and communicate their own perspectives on TB.
It aims to change behaviour – such as persuading people with symptoms to seek treatment – and to foster social change, supporting processes in the community or elsewhere to spark a debate that may shift social mores and/or eliminate barriers to new behaviour.

Figure: Behaviour Change Communication

Resources

Assessment:

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What does the environment created by behaviour change communication encourage the TB-affected communities to do?

Discuss, debate, organize, communicate

Discuss, organize, implement, communicate

Organize, enforce, communicate

None of the above

1

Behaviour change communication creates an environment through which the affected communities can discuss, debate, organize and communicate their own perspectives on TB.

What is SM in ACSM

Content

Social Mobilisation (SM) is the process of bringing together different stakeholders and building partnerships to prevent, detect and cure TB. It generates dialogue, negotiation and consensus among a range of players that includes decision-makers, the media, Non-government Organisations (NGOs), opinion leaders, policy-makers, the private sector, professional associations, TB-patient networks and religious groups.

At the heart of social mobilisation is the need to involve people who are either living with active TB or have suffered from it at some time in the past.

Aims of Social Mobilisation

• Increase awareness of the disease (TB) and the demand for diagnosis and treatment services

• Expand service delivery through community-based approaches

• Enhance sustainability, accountability and community ownership of TB services

Activities for Social Mobilisation

Group and community meetings - Engaging yuva/ mahila mandals, village health sanitation and nutrition committees under the National Rural Health Mission (NRHM), sensitization of local and religious leaders on TB and related stigma in the community. Regular meetings at the village level to address myths and misconceptions and help people with TB symptoms seek timely and appropriate care or referrals.
School activities - Conducting TB awareness campaigns in schools by addressing the school assembly/ class, painting competitions, rallies, road shows, essay competitions, drawing competitions, exhibitions, dramas, pictorial presentations, quizzes, puzzles, puppet shows, leaflet distributions etc.
Traditional media group performances - Performing entertainment-centred folk performances, street plays with scripts centred around TB awareness messages.
Rallies and road shows - Spreading TB related messages on World TB day.
Home visits - Encouraging interpersonal communication and empowering former TB patients and TB champions to become Directly Observed Treatment, Short-course (DOTS) providers.

Here, inter-personal communication and group communication are the main channels of communication for disseminating TB-related key messages.

In the National TB Elimination Programme (NTEP), partner NGOs play an important role in social/ community mobilisation. It generates dialogue, negotiation and consensus, engaging a range of players in interrelated and complementary efforts while taking into account people’s needs.

Resources

Assessment:

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
A roadshow was conducted by local PHC in a village on World TB day with message to End TB. This is an example of:	Policy making	Social mobilisation	Institutional strengthening	Diagnostics	2	Roadshow is one of the activities of social mobilisation strategy which aims at increasing awareness about the disease, involving major stakeholders.

ACSM goals for TB Elimination

Content

Advocacy, Communication and Social Mobilization (ACSM) strategies are directed at achieving specific goals in terms of TB elimination.

They are:

Setting and developing the policy based on the latest evidence
Mobilizing political commitment and resources for TB
Improving case detection and treatment adherence
Widening the reach of services
Combating stigma and discrimination
Empowering people affected by TB and the community at large

It is useful to determine how ‘ideal behaviour’ in the community relates to these goals. The ‘ideal behaviour’ which is promoted through messages and ACSM strategies should be connected to the overall goal of the TB control programme. A few examples of this are:

For the general public: Going to a healthcare provider at the first signs of possible TB infection (ideal behaviour) relates directly to the National TB Elimination Programme (NTEP) goal of increasing the case-detection rate for TB.
For healthcare providers: Following the standards set for the treatment of TB – includes knowing what regimen, how to administer anti-tubercular therapy and what treatment path to take in case of multidrug-resistant or extensively drug-resistant TB. This relates to treatment adherence and outcomes.

The ACSM goals are planned in such a way as to achieve/ address:

• Structural or systemic issues (such as the lack of community Direct Observation Treatment, Short-course (DOTS) programmes)

• Communication interventions (such as behaviour change)

• Individual and social barriers (such as stigma, risk perception and knowledge among populations and health staff)

• Social mobilization activities that promote changes throughout a community or priority group.

Resources

Assessment:

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Seeking healthcare at the earliest symptom of TB directly relates to which goal of NTEP?

Mobilizing political commitment and resources for TB

Improving case detection

Widening the reach of services

Combating stigma and discrimination

2

Improving case detection is an important goal of NTEP and seeking health care early helps in the detection of more number of cases.

Yes

Target Audience for ACSM activities

Content

Identifying target audience is a key step in the process of developing Advocacy, Communication and Social Mobilisation (ACSM) strategy.

Specific target audience need to be addressed to prevent hinderances in achieving the programme objectives.

Figure: Steps in Identifying Target Audience for ACSM Activities

Target Audience for ACSM Activities

Advocacy

• Decision-makers at national, regional and district levels (National Health Mission officials, District Magistrate, National TB Elimination Programme leadership)

• Policy-makers

• Professional groups

• Funders

• Media

Communication

• General public, including different vulnerable groups, healthcare workers (i.e., primary healthcare providers, Allopathic and Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) doctors, private healthcare providers, traditional healers, etc.)

• TB patients currently on treatment as well as cured TB patients

• Contacts of patients with active TB

• People at high risk of developing TB

Social mobilisation

• Communities

• Community groups, e.g., mahila mandals, youth groups

• National and local level leaders

• Local Non-government Organisations (NGOs), Youth organizations, Community-based Organisations (CBOs)

Resources

Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment

Question 

Answer 1 

Answer 2 

Answer 3 

Answer 4 

Correct answer 

Correct explanation 

Identifying target audience is crucial in the process of developing ACMS strategy.

True 

False 

1

Specific target audiences need to be addressed to remove the causes/ reasons that are hindering programme objectives.

ACSM approaches

Content

Once Advocacy, Communication and Social Mobilisation (ACSM) objectives are designed, linking them with activities strengthens the overall programme effectiveness. Several ACSM approaches can be considered for TB. Decisions on which approach or combination of approaches to use should take into account the benefits and risks, the time frame and the expertise and financial resources needed for effective implementation.

There are two parameters to determine:

(1) What ACSM activities to conduct?

(2) Which channels of communication to use?

Following are the various ACSM approaches relevant to the National TB Elimination Programme (NTEP) and the activities included in it:

NTEP Goal	ACSM Approaches	Activities & Channels
Gaining political commitment to TB elimination	Educate national policy-makers and political leaders about the health and economic benefits of TB elimination. Aim to have TB declared a national health priority. Educate local and community level authorities to encourage them to contribute to TB elimination efforts. Solicit the support of international and national partners.	Seminars and briefing meetings Print information (letters, fact sheets) Events around World TB Day and other occasions
Improving case detection	Raise public awareness about TB. Reduce stigma against people with TB and correct misconceptions about TB infection by actively involving current and former TB patients. Help health workers, communities and individuals identify TB cases. Encourage individuals to seek care from appropriate sources. Target hard-to-reach populations (prisoners, urban poor, homeless).	Formative research to determine the best messages and approaches Mass media including radio and television Distribution of print materials at community meetings or events Interpersonal communication and counselling training for health workers Community mobilisation activities
Increasing treatment success and discouraging the spread of Multidrug-resistant TB (MDR-TB)	Give people with TB hope of complete cure. Encourage people with TB to seek treatment from appropriate sources. Provide materials to counsellors. Encourage people with TB to complete treatment even if they improve before treatment ends. Make people with TB aware of possible side effects, and where to seek care, if present. Encourage health workers, family and community members to directly observe people with TB taking their medicine. Engage people who are fully recovered to encourage people currently affected by TB to complete treatment.	Interpersonal communication and counselling training for health workers Mass media, including radio and television Extensive distribution of print materials at healthcare facilities Community mobilisation activities Peer education at community or interest group meetings

Resources

Assessment:

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
Factors to be considered while adopting an ACSM approach include:	Risks & benefits	Time frame	Expertise & financial resources	All of the above	4	Decisions on which ACSM approach or combination of approaches to use should take into account the benefits and risks, the time frame and the expertise and financial resources needed for effective implementation.		Yes	Yes

Communication channels

Content

There are several communication channels for the effective dissemination of messages.

Below are various channels with their advantages and disadvantages listed.

Channels/ Tools	Audiences Reached	Advantages	Disadvantages
Mass media channels
Television	Households, families	Wider reach in urban and rural areas Maximum impact due to audiovisual elements	Expensive production costs Less reach among rural and migrant populations, who are vulnerable to TB.
Radio	Individuals, households, families	Radio production is simple and much less expensive than TV. Relatively wider reach than TV among rural and migrant populations. Accessible even on mobile phones	Radio listening is no more popular; TV viewing/online portals are more popular.
Newspapers and magazines	Educated individuals, households	Timely and fixed schedule of dissemination. Pictorial description of message.	Not useful for the illiterate population People read newspapers for news about political developments, crime, etc., and not for advertisements per se, unless the advertisement is attractive and eye-catching enough.
Mid-Media - Outdoor Publicity Materials and Folk Arts/ Dramas
Posters	Individuals	Strong pictorial description of the message. Useful in high-traffic areas	Brief messages Short lifespan
Pamphlets	Individual	Good for communicating core messages with illustration/ visual support. Mass distribution and a kind of take-home message. Not very expensive. Can be used for repeated exposure and to reinforce messages broadcasted through mass media.	Useful for the literate population, but can be used by the illiterate people as well If the pamphlet looks attractive enough, it is taken home and contents are deciphered with the help of literates or children at home/ in the neighbourhood.
Brochures	Individuals, groups	Detailed information/ instructions with illustrations/ visuals/ graphs etc.	Production costs may be relatively high.
Flip charts	Individuals	Good support in counselling sessions.	Production costs may be relatively high.
Wall writings/ hoardings	Individuals, households	Useful in high-traffic areas. Good for identification, pictorial description and reinforcement of message	Only for the literate population. Message retention is low
Kiosks	Individuals	Face-to-face communication along with audio-visual communication for better message retention. Useful in dispelling myths and practices.	Expensive to scale up. Requires trained staff. Relatively small reach.
Mobile vans and videos on wheels	Groups, community	Entertaining and can grab audience attention and better message retention	Expensive to implement and scale up Relatively small reach Requires precision of timing
Folk dramas	Groups, community	Entertaining and can grab audience attention and better message retention Can touch an emotional chord with individuals/ households; useful for sensitisation.	Relatively small reach. Expensive to scale up. Requires precision of timing. Requires good artists with prior training.
Interpersonal Communication (IPC)
Counselling	Individuals	Credible source due to face-to-face communication. Allows detailed explanation of key health messages. Can help dispel myths and check wrong practices.	Time-taking to build reach. Small reach (individual). Costly to scale up. Requires special training.
Home visits	Households	Credible source due to face-to-face communication. Allows detailed explanation of key health messages. Can help dispel myths and check wrong practices. Useful for rapport building.	Time-taking to build reach. Small reach to the target audience. Requires adequate capacity building.
Community Dialogue
Seminars, workshops, and Parliament questions	Policy-makers, implementers, urban population	Brainstorming of key stakeholders. Identification of key communication challenges, Key inputs from experts and academicians.	Not timely. High cost of implementation. Time-taking to bring about change. Difficulty in mobilizing key stakeholders.
Public meetings and gatherings	Key influencers, individuals, households	Emphasis on key messages by influencers/ stakeholders. Useful for addressing different segments of the target audience together.	Intermittent in occurrence. High organising cost. Only verbal communication involved. Reach is relatively small.
Working with groups	Households, individuals	Dissemination of key messages among communities. Word-of-mouth communication.	Low frequency. Only verbal communication involved.
Social Media
Facebook, Blogs, YouTube, SMS	Individuals	Targets individuals but has a wide/ mass reach. An effective method of reaching a large number. High visibility among decision-makers.	Only limited people have access to internet accounts on Facebook, and an even smaller number have blogs.

Resources

Assessment

Question

Answer 1

Answer 2

Answer 3

Answer 4

Correct answer

Correct explanation

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Part of Pre-test

Part of Post-test

Home visits for communication are an example of:

Mass media

Interpersonal communication

Community dialogue

Mid-media approach

2

A home visit is a form of Interpersonal Communication (IPC).

Credible source due to face-to face communication
Allows detailed explanation of key health messages
Can help dispel myths and check wrong practices
Useful for rapport building

Yes

ACSM activities at different levels

Content

Advocacy, Communication and Social Mobilization (ACSM) activities must place the individual at the centre and bring in the family, community and society to bring about sustained changes in TB perceptions and behaviours. ACSM activities must target these 4 groups accordingly:

Individual: Specific interventions that ensure sustained engagement of people or individuals in maintaining positive behaviours/ changing to desired behaviours. E.g., counselling, use of positive TB messages, message by TB champions, etc.
Family: Interventions that create an enabling environment for promoting positive behaviour change and developing necessary skills for a person affected by TB. E.g., counselling of the entire family.
Community: Mobilizes groups toward a common goal, raises local resources and fosters support and awareness for TB-related issues. E.g., conducting TB awareness campaigns in public meeting places, melas, street dramas, etc.
Society: Advocates for rights-based and socially inclusive approaches and seek support for the TB programme. E.g., workshops and seminars to drive change in legislation, policy, partnerships and resource allocation.

Aimed at individuals, families, communities, and the society, varied ACSM activities are undertaken at the national, state, district and community levels to:

Create awareness and an enabling environment
Build capacities to bring about desired changes in TB-related health behaviour
Sustain positive behaviour

These are shown in the figure below.

Figure: ACSM Activities Spanning Across All Levels

Resources

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
ACSM activities span across which levels?	Individual only.	Individual, family, community, society and from central down to the village level.	Individual and family levels only.	ACSM activities do not span across any level.	2	ACSM activities must span across the individual, family, community, societal levels, and from the central down to the village level.