Mobilizing for Action: Communication-for-Behavioural-Impact (COMBI)

"COMBI is social mobilization with a behavioural bite."

This document from the World Health Organization (WHO) Mediterranean Centre for Vulnerability Reduction (WMC), Tunis, provides an introductory explanation of the Communication-for-Behavioural-Impact (COMBI) approach. As detailed here, WHO has been applying COMBI in the design and implementation of social mobilisation and communication programmes intended to achieve behavioural impact in the prevention, control, and elimination of communicable diseases.

The document answers the following basic questions:

• What is COMBI? - COMBI is directed at the task of mobilising all societal and personal influences with the aim of prompting individual and family action. It is a process which strategically blends a variety of communication interventions intended to engage individuals and families in considering recommended healthy behaviours and to encourage the adoption and maintenance of those behaviours. Starting from people and their health needs (and the specific behavioural outcome desired), it stresses the need for: information, education, persuasion, community involvement, an engaged society, a committed government, and a consumer sensibility which focuses on consumer decision-making and behaviour, applied to healthy behaviours. The 5 integrated communication action areas are:
  1. Public relations/advocacy/administrative mobilisation for putting the particular healthy behaviour on the agenda via: the mass media (news coverage, talk shows, soap operas, celebrity spokespersons, discussion programmes); meetings/discussions with various categories of government and community leadership, service providers, and administrators; official memoranda; and partnership meetings.
  2. Community mobilisation, including use of: participatory research; community group meetings; partnership meetings; traditional media; music, song, and dance; road shows; community drama; leaflets, posters, and pamphlets; videos; and home visits.
  3. Sustained appropriate advertising via radio, television, newspapers, and other media that engage people in reviewing the merits of the recommended behaviour versus the "cost" of carrying it out.
  4. Personal selling/interpersonal communication/counselling, at the community level, in homes, and at service points - with informational literature and personnel carefully listening to people's concerns and addressing them.
  5. Point-of-service promotion, emphasising easily accessible and readily available solutions to health problems.
• Why do we need COMBI? - COMBI is based on the conviction that knowing what to do is different from doing it: "Communication programmes for behavioural impact will need to engage individuals in examining recommended behaviours and to offer the incentives and tugs to action."
• What are the key steps in designing a COMBI Plan?
  1. Identify the overall goal that COMBI will help achieve.
  2. Identify the behavioural objective/s: a statement of specific, measurable, appropriate, and timebound behavioural objectives.
  3. Undertake a situational market analysis using participatory research techniques to identify behavioural issues amenable to communication solutions. This involves listening to people and learning about their perceptions and grasp of the offered behaviour(s) through tools such as TOMA (Top of the Mind Analysis), and DILO (Day in the Life Of), and Force Field Analysis, which helps community members, field staff, local experts, and the COMBI specialist to analyse the social, political, ecological, moral, legal, and cultural factors that could constrain or facilitate adoption of the behaviour.
  4. Establish the overall strategy for achieving the stated behavioural result: re-state behavioural objective; set out communication objectives; and outline communication strategy.
  5. Develop the COMBI plan of action (see the 5 integrated communication action areas outlined above).
  6. Plan the management and implementation of COMBI.
  7. Describe the process indicators to be used in tracking the reach and effect of the communication actions, including a description of how monitoring data will be gathered, shared, and used.
  8. Outline how behavioural impact will be assessed.
  9. Create a detailed workplan with time schedule.
  10. Create a detailed budget.
• How does COMBI differ from health education and promotion? - COMBI integrates principles and techniques of health education and promotion, but COMBI focuses on behavioural outcomes that are made explicit, couples an education and information base with a marketing orientation, and starts from the principle that real barriers that prevent people from choosing to adopt healthy behaviours must be discovered from the very start.
• Where has it been applied? - Examples of programmes in which WHO has applied COMBI include those for: the elimination of leprosy in India and Mozambique, the prevention of lymphatic filariasis in India and Zanzibar, tuberculosis (TB) prevention and control in Bangladesh and Kenya, dengue prevention and control in Malaysia, and malaria prevention and control in Afghanistan and Sudan.
• How can one tell if COMBI works? - COMBI's impact is defined by the behavioural results specified from the outset. The social science research methods of tracking surveys, sample surveys, field observation, and in-depth interviewing allow for measuring the achievement of specific behavioural results.
• Is COMBI a good investment? - "Beyond delivering behavioural results, COMBI's investment value lies in the following: social mobilization will be more strategically targeted from the outset; existing resources will be better utilised; the true constraints and problems affecting behavioural outcomes will be pinpointed; relevant experts will be used much more appropriately; monitoring and evaluation will be more focused and there will be greater understanding and co-operation on the social mobilization outcomes between partners."