Changing Damaging Behaviour
1. Alcoholism 2. Domestic Violence 3. Drug Abuse 4. Female Genital Mutilation (FGM) 5. Sexually Transmitted Infections (STIs)
Most communities have at least one pattern of behaviour that damages those involved – the individual, the partner or the family unit. Changing such behaviour is not easy, but it is worth attempting if the problem is severe.
Usually the approach is to form a group of people with the problem and have regular meetings. You will need a good Group Leader and preferably a supportive Committee to help with the first groups.
With some problems, the group would continue to meet for the lifetimes of those involved: people who abuse alcohol, for example, usually do not say that they are cured – in AA they continue to call themselves 'recovered alcoholics' and go to meetings for the rest of their lives.
» The best-known organisation here is Alcoholics Anonymous. Find out if they have a presence in your country by clicking on the list of addresses outside the USA and Canada. If they do, you can start a group and get support. If not, they have a publication, the 'Big Book' – look at it and think about starting with only local help. AA has a very strong philosophy that involves the idea of 'God As We Know Him' but does not identify specifically with Christianity, Islam or any other faith.
2. Domestic Violence
» Domestic Violence and the presence of guns in the house This story comes from the USA. But there may be a different pattern of violence against children or women in your own community. Guns can hurt an kill; but so can fists; the growth of a child can be damaged by belittling, by being deprived of food or education..... How can it be ended?
» In “Where Women Have No Doctor” chapters 18 & 19 are on Violence against Women/ Rape & Sexual assault (PDF).
3. Drug Abuse
4. Female Genital Mutilation (FGM)
» Maendeleo Ya Wanawake, with technical assistance from the Programme for Appropriate Technology in Health, has been implementing an Alternative Rite of passage programme as part of its efforts to eradicate the practice of FGM in 5 districts in Kenya. Their study, "An Assessment of the Alternative Rites Approach for Encouraging Abandonment of Female Genital Mutilation in Kenya" addressed the factors that influence some families and individuals to adopt the Alternative Rite while others, exposed to the same messages discouraging FGM, decide not to. It also evaluated the effect of the training component of the Alternative Rite on the girls who participated.
Short report summary
Full report (PDF)
5. Sexually Transmitted Infections (STIs)
Running a group:
Unprotected sex with different partners is responsible for a great deal of the spread of HIV/AIDS. In addition, other STIs lead to difficulties in conceiving in later life for the women.
» In folder Health Education for Behaviour Change on page 31 there is a Case Study of a facilitated group to help people treated at an STI clinic. The aim of the group is to change behaviour so that re-infection is less likely. The Case Study includes these guidelines:
HOW TO MAKE A FACILITATED GROUP EFFECTIVE
These groups tend to be informal and develop their own norms and rules. They can meet for extended periods.
The leader does not have to be an acknowledged expert but should know how to manage a group. A democratic leadership style is more effective and is often called facilitation, which means “making things easy”. The facilitator ensures that everybody feels that they are part of the group and has the chance to participate. At the point when each participant feels that they are important and that the group is important, behaviour change may develop in a real and sustainable way.
For this kind of informal group, size is important. For the group to take on its own identity, everybody must know everybody else. For this to happen the group should ideally have around 12 members. If the group is too small – that is, below eight members – it can forget what its task is and just become a friendship group.
Normally the group can suggest its own rules and members will generally mention things like punctuality and attendance. Confidentiality needs to be stressed if the group is to progress; members must agree not to disclose embarrassing details about others. Or a group can agree that things can be talked about outside the group, but nobody can be identified.
Gender mix should depend on the group task. If the task of the group is to provide emotional support to victims of rape, it is preferable to have an all-female group with any male rape victims provided for separately. When it comes to the issue of changing heterosexual sexual behaviour, it is probably preferable to have a mixed group, since both genders usually need a better understanding of the other. If it is all females then they tend to reinforce stereotyped values like “Isn’t it terrible the way men behave – they’re all the same”.
In informal groups the facilitator should sit with the other members; sitting in a circle is sometimes the most appropriate. Rooms should be quiet and free of interruptions. Nurse facilitators should probably change out of uniform into ordinary clothes.