IEC-CH13: Concepts in ACSM

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

1. Advocacy, Communication & Social Mobilization (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment:

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

1. Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment:

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

1. Advocacy,Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment: