What Is It?

Why is it important to take a scientific approach to behavior change related to demand generation? Start with a proven planning tool such as the P Process to develop a communication strategy to drive demand generation.

Click the image above to access a training on the P Process from Johns Hopkins Center for Communication Programs.

One of the most respected tools used in designing social and behavior change communication programs, the P Process is a step-by-step roadmap that can guide you from a loosely defined concept about changing behavior to a strategic and participatory program that is grounded in theory and has measurable impact. The P Process has five steps:

• Step 1: Inquire
• Step 2: Design your strategy
• Step 3: Create and test
• Step 4: Mobilize and monitor
• Step 5: Evaluate and evolve

Increasing evidence suggests that demand generation interventions based on social and behavioral science theories are more effective than those without a theoretical base, especially when multiple theories and concepts are considered.

A strong theory can help design, implement and evaluate effective programs by providing an understanding of the influencing factors on behavior, the way in which behavior change occurs and potential entry points for behavior change interventions.

Ideation is one of the theories and frameworks most often used in social and behavior change programming. Ideation refers to how new ways of thinking (or new behaviors) are diffused through a community by means of communication and social interaction among individuals and groups.

The ideation concept hold that people’s actions are influenced strongly by their beliefs, ideas, and feelings (“ideational factors”) and that changing them can change behavior, including contraceptive behavior. Some of these ideational factors are personal, such as what a person knows about family planning and how they think it will affect them. Others reflect social norms, such as what people believe other people will think of them if they use family planning. The more positive ideational factors a person holds, the greater the likelihood the person will adopt the desired behavior.

What Is the Evidence?

The Nigerian Urban Reproductive Health Initiative (NURHI) successfully used the ideation model in its efforts to increase the use of modern contraception among the urban poor in six Nigerian cities.

Ideation scores calculated at baseline and mid-term showed that among women with more exposure to the NURHI campaign, ideation scores were 13% higher than among women with zero exposure. Women exposed to the NURHI program were more likely to have higher ideational factors, and women with higher ideational factors were more likely to use contraceptives. These cognitive, emotional and social factors that influence contraceptive use included perceptions of social norms about family planning; knowledge, attitudes, and beliefs about family planning; and self-efficacy for using contraception.

Contraceptive Prevalence at Midterm Among Married Women Who Were Not Using a Modern Method at Baseline, by Level of Ideation at Midterm, N = 1,992. Significance of differences across groups: P < .001. Learn more

To understand the dynamics of these determinants in Nigeria, TCI implements periodic population-based surveys augmented with qualitative data and service statistics. Data from multiple rounds of the population-based survey shows that as positive ideational factors (i.e., psychosocial factors that predict behavior) increase, contraceptive use also increases. A review of key ideational results in TCI-supported states showed that women who can confidently recommend use of family planning and can discuss family planning with their spouse are two times more likely to use contraceptives, and perceived self-efficacy increases the odds by 62%. People with adequate knowledge of the various contraceptive methods are four times more likely to use family planning. Similarly, the rejection of myths increased the odds by 68%, while social approval increased the odds by 65%. Using these findings, TCI supports states to develop SBC program activities that address the various ideational factors that are most relevant to a particular state. This is reflected in the messages developed to engage with religious and community leaders, media practitioners and service providers.