Health behaviors and behavior change are key components of many, if not most health initiatives. However, getting individuals to change a behavior that puts their health at risk is frequently more difficult than it might initially seem. While many of us may assume that once people understand the risks, they will make the necessary changes in their behaviors, this is often not true. People, being human beings after all, may well continue risky health behaviors even after the potential consequences of those behaviors are pointed out to them. Various health behavior theories account for the personal, social and environmental barriers and facilitators of behavior change that can influence an individual’s willingness to change. One problem is that health experts sometimes assume they know what those barriers and facilitators of behavior change are within a particular community, when they may well be missing pertinent information. However, surveys and other means of soliciting information from the community may not be the best ways to increasing such understanding. What to do?
Pathfinder International has introduced a Pathways to Change board game, available free online at http://www.pathfinder.org/publications-tools/pathways-to-change-game.html in various languages and in a low literacy version for health outreach workers to use with communties to prompt discussion of behavior change barriers and facilitators. It is fun and noncompetitive – the object is to increase awareness, both on the part of the players and the moderators leading the discussions, about the sometimes hidden factors that may influence people to adopt less risky behaviors (or not). The low literacy version uses pictograms in place of words and letters on the spaces of the board, so that only the moderator must be literate in the language. Working from a brief “character profile” (ideally developed by local community health workers or peer educators so that it is locally relevant) with work, social and educational characteristics and a specific health behavior change objective, each team of 3-6 players rolls a dice to advance on the board and lands on either a Barrier or Facilitator (in either the personal, social or environmental realm), or a Setback space. Depending on which space the team ends up on, it must propose a relevant barrier or facilitator that might influence the behavior change. Of course, if it is a Setback square, the team must move back a certain number of spaces. The moderator’s function is to explain the game and ensure thoughtful discussion among the participants, and keep notes on that discussion. The Moderator’s Handbook includes other related activities to spur discussion.
It is easy to see the use for this type of fun, engaging activity, wherever the geographic locale or whatever the health behavior in question. It also seems easily adaptable to various age groups, even among schoolchildren. While it is a decidedly low tech approach to raising awareness of health behavior change factors, the online availability of the game increases its ease of adoption considerably. How might you use such a tool in your work?