Creating Patient Education That Changes Behaviour: A Content Framework

Short brief: If your patient education handout reads like a lab report and your SMS reminders read like a legal brief, people will ignore both. This guide gives a practical, evidence-based framework you can use this afternoon to design patient education (print + digital + community) that nudges real behaviour change — tailored for African realities: patchy data, many languages, variable literacy, and mobile-first audiences.

Expect: witty field anecdotes, concrete templates you can steal, and citations so you can paste sources into grant applications.

Why behaviour-change focused patient education matters (quickly)

Information alone rarely changes behaviour. To move people from “I know” to “I do,” education must consider capability, opportunity, motivation — and fit into the real day-to-day of the person you’re trying to reach (e.g., bus fares, family decision-making, who controls the purse). Frameworks like the Behaviour Change Wheel / COM-B help designers translate barriers into interventions. Digital tools (SMS, IVR, WhatsApp) can work well — but only when combined with human follow-up and local adaptation. BioMed Central+1

A one-page content framework (the core — copy it into your notebook)

Use this stepwise template for every campaign, leaflet, script, or SMS:

1. Define the behaviour (observable & measurable)

   • Example: “Attend the 6-week postnatal clinic within 6 weeks of delivery” — not “improve maternal health.”

2. Specify the audience (who exactly?)

   • Pregnant teens in peri-urban Kisumu; family decision-makers; CHWs; first-time mothers age 18–24.

3. Set the objective (short & measurable)

   • “Increase 6-week postnatal attendance from 35% → 55% in 6 months.”

4. Diagnose barriers & drivers using COM-B

   • Capability (knowledge, literacy), Opportunity (transport, clinic hours), Motivation (fear, norms). Use formative research (focus groups or rapid surveys). The Decision Lab

5. Select behaviour change techniques (BCTs)

   • Reminders, prompts, modelling, incentives, implementation intentions, social norms messaging. Map these to your barriers.

6. Pick channels & format

   • SMS + voice (IVR) for low-literacy; WhatsApp for urban smartphone users; printed flipcharts for CHWs; local radio for community norms.

7. Draft message(s) & scripts — test for clarity & local language

   • One idea per message; use active verbs; include the clear next step (where/when/how).

8. Design measurement / evaluation

   • Process: delivery rate, open/receipt (where possible), CHW feedback.

   • Outcome: attendance, adherence, knowledge + behaviour measures (pre/post or controlled).

9. Iterate — fast

   • Run A/B small tests (two message variants), use teach-back in clinics to confirm comprehension. AHRQ+1

Practical guidance for each step

1) Behaviour definition — be concrete and time-bounded

“Take antimalarial drugs correctly” → too vague. Instead: “Take every pill from this blister pack for 3 days, starting within 6 hours of diagnosis.” Concrete targets make measurement and messaging simpler.

2) Audience segmentation — one size fits nothing

Segment by age, gender, literacy, phone type, and decision power (who pays for transport?). A peri-urban young mother who owns a smartphone needs a different message and channel than an older woman in a rural village who shares a phone.

3) Rapid formative research — don’t skip it

Spend 3–7 days doing: 6–10 interviews + 2 small focus groups + 10 short intercept surveys. Ask: “What stops you from attending?” and “Who in your family decides about clinic visits?” Formative work pays off — UNICEF and WHO note it’s essential for behaviour change programs. UNICEF+1

4) Use theory — COM-B + Behaviour Change Wheel

Map every barrier to COM-B (Capability / Opportunity / Motivation) and then choose intervention functions from the Behaviour Change Wheel (education, persuasion, enablement, modelling, incentives). This makes your design defensible to donors and MOH reviewers. BioMed Central+1

5) Message design rules (short, local, actionable)

• One action per message.

• Use local languages and common idioms.

• Put the benefit first (“Keeping baby warm reduces infections”) then the action.

• Include a specific next step (where, when).

• Use social proof sparingly (“Most mothers in your village return for the 6-week check”). Evidence-based messaging can nudge norms. UNICEF

6) Format & channel selection — match tech to context

• SMS: cheap, works on basic phones — good for reminders and short prompts (evidence supports SMS for adherence). PubMed

• IVR / voice: ideal for low literacy; record in local languages; schedule calls for convenient times.

• WhatsApp: rich media (audio, short video) for smartphone users and group care; encryption is a plus but check privacy.

• USSD: interactive, works without airtime sometimes, good for quick checklists.

• Radio & community theatre: for social norms and mass reach.

• CHW face-to-face + teach-back: essential — combine digital nudges with human reinforcement (teach-back ensures comprehension). AHRQ+1

7) Prototype & pretest with real users

Write 6–8 messages, record IVR script, and run them past 10–20 target users. Ask: “What would you do after hearing this?” and “Which words confused you?” Iterate quickly.

Case studies — African examples you can learn from

MomConnect (South Africa) — national scale SMS & nurse support

MomConnect sends pregnancy and postnatal messages and provides a helpdesk that links women to nurses. Evaluations show increased uptake of maternal services and high user reach when content was locally adapted and combined with health system links. It’s a model for national-scale patient education that ties messages to service access. PMC+1

WelTel / SMS for ART adherence (Kenya) — simple SMS, strong effect

The WelTel RCT in Kenya showed that weekly SMS check-ins improved antiretroviral adherence and viral suppression — a demonstration that short, two-way SMS can change clinical behaviours when combined with clinician follow-up. Use cases: medication adherence, appointment reminders, symptom check-ins. The Lancet+1

Practical CHW workflow (offline + digital blend)

1. CHW gets brief training (~2 hours) on the campaign & script.

2. CHW enrolls patient via simple form (paper or ODK) — collects phone type and preferred language/time.

3. System schedules messages (SMS/IVR/WhatsApp).

4. CHW does first face-to-face visit with teach-back; documents comprehension. AHRQ

5. Messages reinforce, CHW follows up for non-responders.

6. Weekly monitoring dashboard flags missed visits & override reasons for program manager.

Measurement & evaluation — what to track (keep it minimal)

• Process indicators: % enrolled, % message delivered, % messages opened/played (IVR), CHW follow-up rate.

• Engagement: response rate to interactive messages, call-back requests.

• Outcome indicators (behavioural): appointment attendance, medication pick-up rates, verified adherence, facility deliveries.

• Equity: uptake by language, gender, and rural/urban status.
  Use short pre/post evaluations or stepped-wedge rollouts if feasible. WHO and UNICEF recommend embedding evaluation from day one. World Health Organization+1

Practical message bank (examples you can copy, translate, and test)

For a 6-week postnatal attendance campaign (Swahili/English templates shown as English here):

• Reminder SMS (7 days before): “Hello [Name], congratulations! Your baby’s 6-week check is due on [date] at [clinic]. This visit helps check for jaundice and immunizations. Bring baby’s road token. Reply 1 to confirm.”

• IVR message (2 days before): 30-second friendly voice in local language with next steps and CHW contact.

• Reinforcement SMS (day of appointment): “Today is your baby’s 6-week check. If you can’t come, text HELP and our CHW will call.”

Always include a clear action and an easy way to get help.

Common pitfalls and how to avoid them

• Pitfall: Long messages stuffed with facts. → Fix: One action per message; keep <160 chars for SMS.

• Pitfall: No human backup for non-responders. → Fix: Assign CHW follow-up for all no-responses.

• Pitfall: Using English only. → Fix: Localize language and idioms; test translations.

• Pitfall: Ignoring data costs and device access. → Fix: Offer SMS (cheaper) or schedule IVR at low-cost hours; consider airtime top-ups for participants in pilots. The Guardian

Quick SOP to pin to your project board (one pager)

1. Enrolment checklist (consent, phone number, language, preferred time).

2. Message schedule (frequency, timing, channel).

3. CHW follow-up protocol for 24-hour non-response.

4. Escalation plan for red flags (fever, danger signs).

5. Weekly dashboard review and rapid A/B testing cycle.

6. Monthly formative check with 10 users to surface language or comprehension issues.

Budget & procurement tips (practical)

• SMS/IVR costs: negotiate bulk pricing with local telcos; ask for delivery reports.

• Platform choice: use CommCare, ODK, RapidPro, or a simple SMS gateway depending on complexity. RapidPro and RapidSMS are popular for large SMS/IVR campaigns.

• Human costs: budget for CHW time, refresher training, and airtime top-ups.

• Pilot small, scale fast: run a 3-month pilot with 500–2,000 users to validate assumptions before national scale-up.

Final one-page checklist (copy into your grant or project plan)

• Behaviour clearly defined & measurable? Y/N.

• Target audience segmented and described? Y/N.

• Formative research done? (3–7 days) Y/N.

• COM-B mapping completed? Y/N. The Decision Lab

• Message bank prototyped & pretested? Y/N.

• CHW & human follow-up plan? Y/N.

• Tech platform chosen and telco priced? Y/N.

• Evaluation metrics & budget allocated? Y/N. World Health Organization

References (APA format with live links)

• World Health Organization. (2019). Recommendations on digital interventions for health system strengthening. https://www.who.int/publications/i/item/9789241550505. World Health Organization

• Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. https://doi.org/10.1186/1748-5908-6-42. BioMed Central

• WHO. (n.d.). Actionable — Behaviour change campaigns. https://www.who.int/about/communications/actionable/behaviour-change. World Health Organization

• UNICEF. (2019). Communication for Development (C4D) — Technical guidance. https://www.unicef.org/media/73491/file/C4D-VAC-Technical-Guidance-2019.pdf.pdf. UNICEF

• Lester, R. T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M. H.,… Plummer, F. A. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomised trial. Lancet, 376(9755), 1838–1845. https://www.thelancet.com/article/S0140-6736(10)61997-6/fulltext. The Lancet+1

• Kabongo, E. M., Wadzani, A., Mogeni, T., & Conde-Agudelo, A. (2019). Understanding the influence of the MomConnect programme in South Africa: A narrative review. Global Knowledge Community (HIMSS Global), and peer literature. https://pmc.ncbi.nlm.nih.gov/articles/PMC6609052/. PMC+1

• Agency for Healthcare Research and Quality (AHRQ). (n.d.). Teach-Back: Intervention — Engaging Patients and Families. https://www.ahrq.gov/patient-safety/reports/engage/interventions/teachback.html. AHRQ

• Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and decision making: A systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590951/. PMC

• WHO. (2017). Strategic Communications Framework for effective communications. https://www.who.int/docs/default-source/documents/communicating-for-health/communication-framework.pdf. World Health Organization

• The Decision Lab. (n.d.). The COM-B model for behaviour change (overview). https://thedecisionlab.com/reference-guide/organizational-behavior/the-com-b-model-for-behavior-change. The Decision Lab