Learning From the Past: The Role of Social and Behavior Change Programming in Public Health Emergencies

Abstract

The prevalence of emerging infectious diseases (EIDs) is rising at an unprecedented rate, and influencing human behavior is often the first line of defense to slow disease transmissions. n We synthesize the contributions that social and behavior change research and programming has made in 6 recent EIDs that reached epidemic proportions: HIV, severe acute respiratory syndrome, Middle East respiratory syndrome, Zika virus, Ebola virus disease, and coronavirus disease. n Analysis of successful and unsuccessful responses to EID outbreaks suggests 5 primary lessons learned that can be used by SBC experts in future EID responses: engage communities, build trust through transparent risk communication, segment audiences for tailored interventions, prioritize behaviors, and cultivate political will and commitment. n Incorporating SBC experts into EID responses can reduce mortality and improve efficiency in such precarious and time-sensitive settings. INTRODUCTIONT he prevalence of emerging infectious diseases (EIDs) is rising at an unprecedented rate as a result of globalization, deforestation, economic growth, increased human mobility, urbanization, and fragile health systems. [1][2][3][4][5] When new diseases emerge, medical and public health practitioners quickly begin to evaluate strategies to mitigate disease transmission and to use clinical interventions that can prevent or treat the emerging disease. 6 However, behavioral responses-and the systems and structures that shape behavior-are often the first line of defense. As Dr. Deborah Birx stated during a press briefing on the coronavirus disease (COVID-19) response in March 2021, "there's no magic bullet . . . it's just behaviors." 7 Social and behavior change (SBC) refers to activities or interventions that examine and facilitate behavior change and the social and environmental factors that drive them. 8 This includes behaviors leading to the prevention of disease transmission and those related to the promotion of health and well-being, as well as actions addressing structural and institutional environments. SBC contributions to EID preparedness, response, and recovery are distinct. 9 Here, we focus on public health emergency response, in the context of which SBC experts develop approaches to reduce disease transmission under difficult and rapidly evolving circumstances.Encouragingly, there have been notable advances in including SBC strategic approaches at the outset of public health emergency responses. In the International Health Regulations 2005 and Joint External Evaluation Tool, risk communication and community engagement are central to the World Health Organization guidance around communication in emergencies, 10 and the U.S. Agency for International Development included SBC communication as 1 of 3 response pillars during the recent Zika outbreak in the Americas. 11 However, despite these contributions, SBC experts are still not consistently included in outbreak response teams. 12 This is due to limitations in human and financial resources and an "evidenc...

Examining the characteristics of social and behavior change communication intervention costs in low- and middle-income countries: A hedonic method approach

“…SBCC interventions encompass a wide range of interventions including mass media (e.g., radio, television (TV)), mid media (e.g., community announcements, live dramas), digital media (e.g., short message service (SMS)/phone reminders, social media), interpersonal communication (IPC) (e.g., individual or group counseling), and provider-based SBCC interventions focused on improving provider attitudes and provider-client communication [ 14 ]. The success of these interventions is critical in responding to health needs and ensuring the overall success of global health interventions [ 15 , 16 ].…”