Section 1: Outcomes: Communication for Social Change: An Integrated Model for Measuring the Process and Its Outcomes

Section One: An Integrated Model of Communication for Social Change

Outcomes


The state of the community in terms of the status of the individuals who comprise it as well as the community as a whole can be measured at any time before, during and after a development project has been undertaken. The differences between individual or social characteristics of a community from one point of time to another provide an indication of the change that has occurred while the community was engaged in community dialogue and collective action. The lower left-hand side of the model lists the most prevalent types of individual change that can occur, which are based in stage models of behavior change (Rogers 1971, 1995; Prochaska, 1992; Piotrow et al., 1997) and ideation models of behavior (Kincaid 2000, 2001).

A thorough discussion of individual change is beyond the scope of this report. As Figure 2 shows, the potential outcomes of dialogue and collective action for the individuals who participate include: (1) improvement in skills necessary to perform new behaviors; (2) ideational factors such as knowledge, beliefs, values, perceived risk, subjective norms and even self-image; emotional responses such as feelings of solidarity, empathy and confidence; and increase in social support and influence from others as well as increased advocacy to others; (3) intention to engage in new behavior in the future; and (4) specific behaviors related to the problem addressed by the dialogue and collective action. The model also indicates that these individual outcomes can be the result of the direct influence of one of the external catalysts identified in the model, such as mass-media messages that promote specific health practices and the introduction of health clinics near a community.

The right-hand side of the model lists seven possible outcomes of social change that may occur. A definition and measures for each one of these outcomes is provided in Section 3 of the report. Many of the individual and social change outcomes are related and can affect one another. For example, the knowledge that individual participants have about a health problem is aggregated at the community level to determine the average level and distribution (equity) of that type of knowledge in the community. Where the perceived social norm is that both men and women are expected to participate in community meetings, we would expect to find a majority of women saying that they think, "Most of my friends expect me to come to the meeting and participate." If this behavior is encouraged and rewarded during collective action, we would expect a greater number of women to report afterwards that they did indeed participate (an individual outcome), leading to an overall increase in the degree and equity of participation with the community (a social outcome).

There is no better example of the relationship between social and individual change than the case of malaria prevention by removing stagnant water sources in the area around one's own home. If only a few individuals in a community do this on their own, their (individual) behavior will have little impact on the mosquito population. However, if through dialogue a consensus is reached among everyone (or a critical mass of community members) and they all take joint action at the same time (social behavior), then the strategy can lead to an effective, long-term solution to the problem of mosquito-born diseases. The primary focus of Communication for Social Change is on the social outcomes of dialogue and collective action. If a community effectively completes the steps outlined in the model and then accomplishes one or more of the objectives it sets for itself, then we would expect some potentially profound social outcomes within the community, above and beyond what happens to the individual members who participate or benefit. For example, if leaders successfully engage the requisite number of stakeholders, facilitate the expression of individual and shared interests, resolve conflicts, and help create a vision for the future in ways that they have never used before, then those leaders learn something that they can use again. In one sense these are individual leadership skills, but leadership cannot be practiced in isolation from followers. Leadership is a joint behavior that takes place between leaders and their followers, and hence is a characteristic of the group or community in which it occurs. In other words, an improvement in leadership is an indication of social change as well as change in the individual behavior of specific leaders.

The same implication applies to followers as well. Participative leadership and an increase in the shared decision making and power within a community requires followers to change their behavior as well. Although it may appear that a greater burden falls on leaders, the 15 steps specified in the model require effective followership — the appropriate response and cooperation of other members of the community. In many cultures, for example, where women, following long-held traditional norms, have not attended community meetings or have attended without speaking, it would be very difficult for a leader by himself to suddenly ask for women to participate actively and on an equal basis with men. Doing so could easily turn into a "token effort" that results in a reinforcement of the shared belief (stereotype) that women really do not want to participate or are simply unable to do so. On the other hand, a leader who identifies the most influential women and who meets with them beforehand to plan and prepare for their participation is much more likely to succeed. He/she is developing a change in the relationship before asking for change in the behavior of particular individuals and for a change in the norms governing behavior in community meetings. Leadership and followership is a characteristic of the community as a whole because it is based on the relationship between leaders and followers rather than on a set of traits possessed by either one alone.

In the same sense, while we can measure individual gains in knowledge about a problem and its solution, individual levels of knowledge can be aggregated as the proportion of community members who are knowledgeable or as the average level of knowledge of all the members. The average level of knowledge can be high in a situation where (say) half the people have a lot of knowledge and the rest have hardly any. Statistically, this is a bipolar distribution. Since one of the implied social goals of the social change model is knowledge equity, then emphasis must be placed on the extent to which the knowledge is shared within the community as opposed to hoarded or monopolised by just a few. The width of the distribution (standard deviation) around the average level of knowledge offers an indication of how widespread knowledge is as well as its average level.

Changes in the frequency of participation and the proportion of community members who participate in dialogue, decision making and implementation, along with the diversity of participants in terms of education, occupation, gender, ethnicity, and so forth, provide a measure of social change of the community in terms of degree and equity of participation. Such a change is a desirable outcome of a participatory development project in and of itself, regardless of expected changes in individual health behavior and status, because such changes at the community level are expected to have a positive impact on the success of the project and on the capacity of a community to deal with its next problem. Perceived ownership, cohesion and a value for continual improvement is also expected to follow from increased participation and shared decision making.

When community dialogue and collective action are implemented in the manner specified by the model (the 15 steps), we expect not only an improvement in the health status of community's members, but also an increase in the following:

• Community's sense of collective self-efficacy — the confidence that together they can succeed in future projects,
• Sense of ownership — the degree to which they perceive themselves as responsible for the project's success and thus feel that they deserve the credit and benefits from the project,
• Social cohesion — the extent to which members want to cooperate in another community project and the degree to which the social network of the community is interconnected as opposed to divided into cliques and factions,
• Social norms — the accepted rules for participation, especially regarding who should or should not speak up and share in decision making and "fairness" regarding contribution and sharing of benefits, and, finally,
• Collective capacity — the overall ability of a community to engage in effective dialogue and collective action that is a consequence of all of the social change indicators specified by the model.

Social scientists have developed the concept of "social capital" to account for a community's capacity to cooperate for mutual benefit (Collier, 1998; Krishna and Shrader, 1999). Putnam (1993) defines social capital as the "features of social organisation, such as networks, norms and trust, that facilitate coordination and cooperation for mutual benefit." The concept can be traced back to James Coleman (1988), who proposed that social capital consists of a variety of different entities with two elements in common: some aspect of social structure that facilitates the actions of actors within the structure. Like economic and human capital, "social capital is productive, making possible the achievement of certain ends that would not be attainable in its absence, but unlike other forms of capital, social capital inheres in the structure of relations between persons and among persons. It is lodged neither in individuals nor in physical implements of production" (Coleman, 1990, p. 302). Nan Lin (1999, p. 9) defines social capital as "investment in social relations by individuals through which they gain access to embedded resources to enhance expected returns of instrumental or expressive actions."

To qualify as a type of capital, the social capital of a group must be capable of being increased by means of some type of investment (in resources and work). Social capital as a form of surplus value, must be capable of being increased and captured by means of some process. Thus, from the perspective of social capital, the dialogue and collective-action process described in our model is a learning process, in which individual members through their participation in community projects increase their capacity for cooperative action with one another and form social structures — networks, teams, leader-follower relationships — which increase the community's overall capacity for future collective action. Information sharing, coordination of activities by leaders, joint decision making and the equitable distribution of participation and benefits all provide an incentive for further cooperative action, increase the productivity of the community as a whole and create a shared value for continual improvement.

The Interaction of Individual and Social Change

For health, as well as many other areas of development, individual and social change are both necessary for attaining sustained health improvement. Table 1, below, shows what is expected to happen as a result of individual change by itself, social change by itself, neither social change nor individual change, and finally the interaction of individual and social change.

Individual change by itself is usually the expected outcome of health promotion programmes, especially those dedicated to a single health problem such as the use of oral-rehydration therapy to reduce childhood diarrhea, immunisation programmes, family planning programmes, condom promotion for HIV/AIDS prevention, and mosquito-net use. The urgency of the problem, the initiative taken by centralised agencies, the concentration of resources, the specific focus, and the concrete and limited nature of the behavior to be changed, all increase the efficiency and likelihood of success. It is not surprising to find, therefore, that individual behavior-change programmes are quite common in the field of public health. By design, however, the outcomes are limited to a single, specific aspect of health. As a consequence, some individual behavioral change may even be limited to a short duration in time unless other measures are taken to ensure that such changes are institutionalised and self-sustaining.

In a situation where only social change occurs, the capacity or potential for improvement in health or other areas of development may increase but with little impact if not accompanied by the required changes in individual behavior. Changing a community's leadership patterns, initiating a dialogue about problems that resonate with everyone and even jointly deciding on a course of action may all improve a community's capacity to solve problems, but if it is not accompanied by the required changes in the behavior of individual members, then very little progress will be made on specific problems. Ironically, communities may have to conduct their own internal health-promotion programmes to get their members to adopt the appropriate behavior. If neither social nor individual change occurs, then we would expect the existing status quo to be maintained.

The ideal change process would result in social change and in the requisite individual change. We expect the interaction of these two types of change to result in self-sustained improvement in health and other problems faced by a community. Every time a community goes through the dialogue and collective-action process and actually achieves a set of shared objectives, its potential to cooperate effectively in the future is also expected to increase. If the process also leads to the changes necessary in individual behavior for a community to achieve its objectives, then the success of the community reinforces both collective and individual behavior. The likelihood of a community continuing to solve problems together in the future is expected to increase. Furthermore, the confidence of the community to undertake collective action increases and the value for continual improvement is strengthened and institutionalised. The possibility for self-sustained, continual improvement can become a reality.

The question of which type of change should receive the highest priority is sometimes very controversial. We must keep in mind that we should not expect every local community to invent its own solutions to every problem, especially for problems in which specific technology such as vaccinations, antibiotics or contraceptives can be made available from outside authorities in the "larger community," such as local and national governments or international development agencies. Even in this obvious situation of individual adoption, however, a community response may be necessary to obtain such technologies from the outside.

Oral rehydration solution (ORS) for the treatment of diarrhea, a leading cause of infant mortality, underscores these issues. ORS has saved millions of lives, but the alternative solution of hand washing with soap, improvement of latrines and clean water within the community as a whole would be expected to have a greater impact on childhood diarrhea than the treatment of one child at a time with ORS after an infection occurs, especially if some of the ingredients of ORS are not always available. Both external policymakers and local community leaders have to find the appropriate balance between social and individual approaches to change, a balance that best fits the problem itself and the needs of the members of the community.