The Communication for Behavioural Impact (COMBI) methodology is designed to produce behavioural results, not only to increase awareness and knowledge. COMBI draws on many disciplines to design communication strategies for behaviour change: marketing, advocacy, public relations, education, psychology and anthropology. It is based on successful experiences in both the public and private sectors to encourage the adoption of specific behaviours.

COMBI is a planning framework and implementation method that uses communication strategically to achieve positive behavioural and social results. Its communication programmes are designed to engage individuals, families, communities and nations and encourage them to consider and take action on specific recommended behaviours that could make a difference to the quality of their lives. 

COMBI involves the following ten steps:

• Step 1: Set out the overall goal
• Step 2: Set out preliminary, tentative, specific behavioural objectives 
• Step 3: Carry out a situational market analysis
• Step 4: Present the communication strategy
• Step 5: Present the COMBI plan of action
• Step 6: Present a plan for managing the implementation of the COMBI plan
• Step 7: Present a plan for monitoring implementation
• Step 8: Present a plan for assessing behavioural impact
• Step 9: Develop a calendar/timeline/implementation plan
• Step 10: Prepare a budget

The method begins with a precise definition of the behavioural result(s) expected in relation to people’s needs, wants, or desires. No communication activities are undertaken until specific behavioural objectives have been selected in step 2 and a situational market analysis (SMA) carried out in step 3. ‘Market analysis’ here is used in the sense of the Social Marketing F.21 of a behaviour. The SMA involves listening to people and learning about their perceptions of a specific behaviour. It explores factors that would constrain or facilitate the adoption of the behaviour and people’s expectation of the costs (time, effort, money) compared to the value of the behaviour. COMBI integrates five communication action areas into its approach (1) political mobilisation, public relations and advocacy, (2) community mobilisation and engagement, (3) advertising, promotion and incentives, (4) personal selling, interpersonal communication and counselling and (5) point-of-service promotion. 

Tools and Methods used

Applicability

COMBI is suitable for all response phases and can be applied in a rural as well as urban context. A well-implemented COMBI process can also lead to appropriate preparedness and mitigation activities with greater support from and engagement by the concerned communities. The COMBI methodology has been widely used to identify behaviour changes related to the control of disease outbreaks and suitable actions for disease prevention. COMBI has been mostly used in the (public) health sector, including WASH-related interventions. It has also been used to achieve behavioural change objectives in a wider social development context, including in interventions that address violence against women or children’s education. A potential area of COMBI application in the future may be to address behavioural issues related to an increasingly urbanised world.

Main Requirements / Investments Needed

Organisations planning to apply COMBI should allocate sufficient time and resources for the process and not rush assessments, especially the process of listening to people. Staff should be trained well in its application and provided with ongoing support.

Evidence of Effectiveness

The COMBI methodology was developed in 1994. WHO began successfully using it in 2000 in disease control programmes in developing countries worldwide. The essential prerequisite for measuring impact is having clear behavioural outcomes as programme goals. One of the most successful COMBI projects was in Cambodia where in one year UNICEF achieved a 600% increase in the numbers of women making their first antenatal visit within 8-12 weeks of missing their period.

Do

• Be very specific and detailed on the behaviour to be addressed with COMBI

• Plan sufficient time to apply all steps of the COMBI process

• Connect to and engage the intended target group of the behavioural change process 

• Carry out market research about the desired behaviour and services (e.g. attendance at clinics providing a specific service)

Don't

• Do not create new needs. Instead, respond to existing needs, wants and desires

• Do not make assumptions but use participatory research methods to identify the actual barriers and constraints that prevent or facilitate the adoption of healthy behaviours.

Practical Example

In Johor Bahru, Malaysia, a three-month COMBI programme resulted in 85% of households in the sampled areas carrying out the desired dengue control-related behavioural tasks over a 12-week period. Three months later, 70% were still maintaining the checks. COMBI has also been applied successfully in programmes where health and hygiene are interlinked e.g. a leprosy control intervention in Bihar, India where COMBI contributed to an increase in early case detection through improving the number of people self-reporting to clinics (a 73% increase for females reporting). The COMBI methodology was also instrumental in the successful implementation of health behaviour communication in Cambodia where it was applied in the planning and implementation of a nationwide ante-natal care behaviour change communication campaign.