There are various definitions, insights and experiences associated with IEC. But we would like to share a manuscript from the World Health Organization's Department of Reproductive Health and Research as they implemented their Nutrition Communication Project in 1996. We think this captures the essence of what IEC is all about and provides an excellent reference for those who are yet to explore its organizational or project management benefits.
iecspecialist.com will be happy to partner with you in carrying out many of the recommendations in this page.
About Information, Education and Communication
IEC can be defined as an approach which attempts to change or reinforce a set of behaviours in a "target audience" regarding a specific problem in a predefined period of time. It is multidisciplinary and client-centred in its approach, drawing from the fields of diffusion theory, social marketing, behaviour analysis, anthropology, and instructive design.* IEC strategies involve planning, implementation, monitoring and evaluation. When carefully carried out, communication strategies help to foster positive practices individually and institutionally, and can contribute to sustainable change toward the desired behaviour.
IEC succeeds when it is planned with a comprehensive strategy. This means having clearly articulated objectives, keeping the client at the centre of what is being designed, conducting appropriate research, undertaking audience segmentation, carefully crafting and testing messages, knowing and using appropriate channel choices, and planning for monitoring and feedback.
IEC succeeds when it is planned with a comprehensive strategy. This means having clearly articulated objectives, keeping the client at the centre of what is being designed, conducting appropriate research, undertaking audience segmentation, carefully crafting and testing messages, knowing and using appropriate channel choices, and planning for monitoring and feedback.
In the case of reproductive health initiatives, for instance, it is important to know and incorporate community traditions (e.g., disposal of placenta, respecting preferred birth position), and to "follow the community at its own rhythm". Communities will test you and credibility takes time.
Much can be achieved through a comprehensive IEC intervention which emphasizes long-term capacity building at the grassroots level. In this respect, the community is vital; it is not simply a message channel or a passive recipient of services or information.
IEC issues overlap with related issues of service delivery, quality of services, community participation, and so on. There must be a true dialogue around a wide range of issues relevant to public health during the planning stage.
Changing behaviour is not an easy or quick task. An ideal campaign is sustained over time to foster changes in social and behavioural norms.
It is important to remember that everything cannot be changed at once. Also, it is important to focus on what is relevant or not relevant, and consider not only information but also the "knowledge-behaviour gap".
IEC interventions are more cost-effective when there are clear links with health care service delivery programmes rather than when they are conceived as stand-alone IEC projects. From a communication perspective, this makes vital the quality of client-provider contact. Provider behaviours require monitoring, reinforcement, and updating. The lack of a supportive environment from the health care provider is also a factor that can hinder individual behaviour change.
People learn new behaviours best: when they are learning something they feel is useful, when they can put into practice what they are learning, and when they receive feedback and are rewarded for doing well. Modelling is often the best way to teach complex behaviours.
Programmes that seek to teach new behaviours work best when they define through research what the problem really is, who it affects, how those people understand and respond to the problem, what obstacles they are likely to encounter, and how the audience can be influenced to change. A particular behaviour can be part of a complex set of behaviours with differing responses to each component along a continuum of change.
Sound programmes also use audience segmentation (i.e., the grouping of audiences by demographic, social, and psychographic variables), marketing techniques, behaviour analysis, and anthropological research to create messages that are salient, action-oriented and attractive. They test those messages, integrate communication channels, monitor and evaluate regularly, and commit to the long haul.
Getting information on which to base an IEC strategy doesn't need to be time-consuming, costly and complicated. A short list of highly specific questions can keep formative research focused on essential issues, i.e., identifying concrete and realistic behavioural targets for the different audiences, ways to reach each audience, and appropriate messages for each audience.
The type of information needed will drive the research methods to be used. Most programmes require a mix of ethnographic, market, observational, attitudinal, consumption and epidemiological research. Hybrid approaches (qualitative and quantitative) are often best and are not necessarily more costly or time-consuming.
More effective campaigns combine mass media with community, small group, and individual activities, and are supported by an existing community structure.
Campaigns for preventive behaviour are more effective if they emphasize positive behaviour change rather than the negative consequences of current behaviour. Fear arousal as a campaign strategy needs to be used with caution. It is rarely successful as a long-term campaign strategy.
In message design, be aware that people seldom like to be told what to do.
The timing of a campaign helps to determine its effectiveness. For example, in diarrhoeal disease campaigns, seasonality is an important consideration since diarrhoeal disease often occurs in the rainy season.
If more than one set of messages is being delivered via an umbrella campaign (e.g., several issues are being covered under one unifying theme), phasing of messages might be important to avoid information overload.
Support of community leaders, public opinion leaders and decision-makers can lead to stronger results. The use of such identifiable and credible sources (in the Philippines, they are often called the speakers' bureau) of information can enhance the success of an IEC initiative.
Actively involving the target audience in the design, implementation and monitoring of a project is critical. Listen to local language, custom, and experience. Negotiate the relevance of an intervention with the audience. Make sure the intervention addresses reality "on the ground".
Establish linkages and relationships with, and actively involve, traditional healers, local nongovernmental organizations (NGOs) and local support groups, and recognize the important role each plays. Share information with them.
Iinterpersonal communication and counselling skills can be very critical to successful programming. The interaction between health care providers (at all levels) and clients for instance is important for successful IEC interventions. This is where one stage of decision-making takes place. Provider behaviour is critical and the need for behaviour and attitude change among health workers has been established. (Physician resistance to change, as well as punitive actions by all other levels of health worker, is well documented.)
Multimedia campaigns are most effective when mass media and popular traditional channels are used in combination with person-to-person interactions. There is less power in stand-alone multimedia campaigns than in campaigns that link the power of media and the power of individual persuasion with service deliver.
A media campaign should use diverse broadcast and distribution channels, combining television, radio, print and traditional media, in order to maximize penetration and impact. More attention needs to be focused on the mix of channels used in a given situation. Achieving "reach and frequency" in communications takes careful research and planning.
Decisions about media channels and frequency and intensity of broadcast or distribution should be closely tied to initial and ongoing research with the target population.
Take advantage of local holidays and festivals to disseminate messages or for inaugural events.
IEC interventions cost money to implement and to sustain over time. There is an imbalance between expectations about what IEC can do and the resources allocated to carry out those interventions. It is important to realize that change within five per cent of a designated population represents good progress. Remember, even Coca-Cola never stops promoting its product.
Logos and symbols offer a way to create unity between a wide range of communication messages, allowing the target audience to build up interpretations and meaning over time. However, certain symbols are recognized at only certain levels of the population. Assure that you have adequately tested a symbol or logo and are aware of the audience’s understanding or interpretation of the same prior to launching.
The use of logos and symbols in advocacy campaigns has also been successful. The red ribbon has come to symbolize the international struggle around HIV/AIDS, but this meaning has only developed through continued association with other HIV/AIDS messages. The White Ribbon Alliance for Safe Motherhood raises awareness about the need to make pregnancy and childbirth safer for all women and infants.
A campaign should reach relevant segments of the target population with meaningful messages; materials should have broad appeal and, at the same time, some materials should be tailored to meet specific subsets (e.g., by gender, age, race, economic status). It is important to direct messages at specific behaviours and when defining behaviours to think about action/target/context/time (e.g., "Always use condoms correctly when having vaginal sex with your main partner.") A media campaign should be ongoing and responsive to shifts in the market and the audience in order to prolong and sustain its impact.
Media campaigns need to reflect an entire programme’s behavioural objectives through appropriate message cycles to targeted audiences. Such messages should support existing desired behaviours, promote new behaviours as necessary, and alter unhealthy behaviours. Conditions must be in place to support whatever behaviours are being promoted. For example, birth spacing messages might reinforce dialogue between partners, encourage clinic visits for contraception, and address community social norms that advocate large families. It is then incumbent upon reproductive health facilities to have trained practitioners and counsellors on hand to facilitate these behaviours.
Sometimes it is important to anticipate trouble and to develop a crisis communication plan if the intervention is considered controversial. It may be important to determine in advance who will act as spokesperson for the programme and s/he should be prepared. Centralizing information for dissemination to the public may help to avoid problems. It is important to communicate with all key audiences and to maintain good relationships with them. Know who the possible opponents are and, in so far as possible, build trusting relationships. Remember that people respond best to facts. Listen first, then act. Be prepared to make short-term sacrifices for long-term gains.
Facile pretesting can yield poor information. Many erroneous conclusions have been attributed to superficial testing for such things as comprehension. Observations of materials in use and trial periods can help to detect problems. Go beyond simple focus group discussions. Use different approaches to collect information, and remember that moving from data to messages is difficult.
Simple, inexpensive print materials can be useful and more cost-effective than more expensive and elaborate products, i.e. counselling cards are helpful for use by health workers. Also, graphic materials for home use can be important, especially in empowering women to negotiate their reproductive health needs. Materials like fotonovelas (similar to comic books but using photographs) have been used to assist women in Latin America, for example, to negotiate with their sexual partners.
It is important to move beyond the "I need a poster" syndrome in developing print materials. Choosing the right print product can be difficult and requires rigorous exploration and selection. Be sure to tailor materials to the appropriate literacy level, even when developing materials which only require visual literacy.
IEC materials are more widely distributed when their distribution system is combined with relevant health commodities (e.g., distribution of contraceptive commodities simultaneously with posters for family planning).
Distribution of print materials may occur more effectively if contracted out to the private sector. The failure to plan for, implement and maintain distribution systems is often a major failing of IEC efforts. Stories of materials, video cassette players, and other materials and equipment "sitting around gathering dust in warehouses" abound.
Monitoring and Evaluating an IEC Strategy
Monitoring has been neglected as a tool for understanding operational dynamics and for detecting what works or doesn’t. Inexpensive methods for monitoring can be used and should be explored (e.g., observation).
Documentation of programme inputs and implementation experiences is important for understanding successes and failures. Methods for doing this should be institutionalized as part of management information systems.
Evaluation of IEC efforts is a complex task and should be considered from the very beginning, when projects are being planned and not just after they are underway or completed. Involving specialists in research design and evaluation early on can ensure that process and impact evaluations are valid and reliable.
There is a need for extreme specificity in questions asked in an evaluation, especially in countries where multiple interventions have been carried out. Carefully constructed questions are very important. In designing questions, messages must be carefully analysed so that primary messages (e.g., "breast is best") are distinguished from secondary messages (e.g., promotion of weaning practices).
The research and evaluation team should be given an opportunity to fully understand the project. The stronger the understanding between programme staff and researchers, the better the product.
Evaluation should be considered a learning tool by programme staff and should be embraced as a resource for programme redesign.
An evaluation framework should be responsive to programme needs, and should feed information and data back to programme staff to allow for corrections and adjustments to programme components during implementation. Evaluation should not impede implementation. As one evaluation expert put it, "We will rarely have evidence that is incontrovertible; nonetheless, we still need to act sensibly on the best evidence we have."
Recognizing that research and evaluation designs may have limitations and factoring in those limitations when assessing the effectiveness of programme strategies can contribute to more successful outcomes.
Provided with relevant training, non-IEC professionals can coordinate the development of good quality IEC materials and approaches. In order for training to be relevant, it must take into account the role and job description of the persons being trained. People should not be trained just for the sake of training. All training designs should be seriously deliberated and individualized in order to meet the needs of the programme and of those being trained.
People need training in materials use and distribution as well as materials development.
Phased training, focusing first on skill building and then on skill transfer, is a successful model. It allows trainees to practice their new techniques (e.g., counselling) before actually becoming trainers of others in the same skill area. This enhances overall programme sustainability. A competency-based approach to training is most effective at building skills.
Training should be curriculum-based and apply the principles of adult education.
Like other programme components, training should be evaluated, and those who are being trained should be involved in developing the curriculum.
Even when trained, people have difficulty discussing personal matters (such as sex) with others. IEC training needs to address this problem, and to provide specific techniques for opening dialogue and moving it forward. It must also address the need for health care workers to come to grips with their own behavioural and cultural biases. (For example, can a midwife act against female genital mutilation in a believable way if it has been done to her and she has allowed it to be done to her daughters?)
There is a pressing need for training in IEC techniques that effectively motivate people to express their genuine desires relating to reproductive health. Similarly, training design needs to take into account the desires of trainees and/or providers as well.
It is most effective if the number of levels of trainers is kept to a minimum. That is, instead of having different trainers for each level (i.e., province, county, township, village), have perhaps two levels of trainers responsible for all training activities. The fewer the number of levels, the less opportunity for important content to be lost during training of trainers workshops.
Ensure that appropriate training materials are available for community level workers. This includes budget considerations to assure funding so that adequate materials reach all levels, not just those at the higher levels.
Include leaders and managers in the programme or establish a parallel programme for them to ensure they understand the importance of interpersonal communication work and will support it in future.
A client-centred approach to training can have dramatic results in terms of service delivery. A consumer perspective requires that health workers understand the client's circumstances, that they seek solutions to problems in collaboration with the client, and that they are systematic about follow-up.
Well-designed and tested training modules can serve as reference points for national and local training programmes. In designing materials for widespread use or for local adaptation, three strategies can help assure relevance and widespread use: involving a wide range of potential user organizations in identifying needs and issues; involving them in pretesting the materials in their respective programmes; and involving them in the translation and publication of materials.
Incorporate interpersonal communication principles and skill training in regular, pre- and in-service training programmes.
Include in any training curricula, sessions on how to conduct audience research and how to use the results to adapt training materials for use at different levels.
Include as many posters, models, and other teaching aids as possible in training programmes to supplement curricula and training materials.
Schedule follow-up or refresher training.
Be sure that clearly articulated job descriptions with realistic expectations are reviewed regularly and that supervision is ongoing.
Important IEC lessons (based on WHO's 1996 Nutrition Communication Project)
The most important lesson learned in IEC is that it works. It creates awareness, increases knowledge, changes attitudes and moves people to change or continue their behaviour or to adopt an innovation.
Very rarely does a person make a decision alone. To make a lasting change in one individual, the key influentials must be identified and encouraged to support these changes.
Mass media helps to create an agenda for public debate. It reaches many people and is not that expensive. However, to be effective, mass media must be supported by interpersonal and group communication.
Communication channels should ensure availability of feedback mechanisms. This is important for reinforcement and for clarifying questions and issues.
Personal testimonies of affected people are far more compelling than any other form of communication. Fear arousal is seldom effective.
When a communication programme is designed and carried out by expert practitioners, it is more likely to achieve success.
A mass communication programme dealing with sensitive issues socially validates open discussion of these issues, thus making them part of the everyday agenda.
In order for a communication campaign to be successful, the relevant social services infrastructure should be prepared to satisfy the increased demand for services created by the campaign.
An important element in a health communication campaign is an adequate blend of entertainment and social messages.
A continuing barrier to the success of IEC interventions is limited resources and unrealistic expectations.
Resources need to be devoted to producing salient materials in sufficient quantity, to establishing a workable distribution and reordering system, and to showing service providers how to use materials. Also needed are basics: signs showing the way to services, what services are available and what they cost, days and hours of service delivery, and how one can access services.
