Community-Based Social and Behavior Change Communication for Health Promotion in Fragile Settings: Evidence from Somalia

Abstract Background Social and Behavior Change Communication (SBCC) is increasingly used to improve health knowledge, strengthen community participation, and promote positive behavior change. In fragile and conflict-affected settings, however, SBCC is shaped by weak institutions, limited service coverage, low literacy, displacement, cultural beliefs, and unequal access to communication technologies. Somalia provides an important case for examining how culturally grounded SBCC can support health promotion and community resilience. Objective This study examined the perceived effectiveness of SBCC strategies in Somalia, with specific attention to community awareness, trusted messengers, communication channels, implementation barriers, and policy implications for health promotion in fragile settings. Methods A mixed-methods exploratory design was used. Quantitative survey data were collected from 150 respondents, while qualitative interviews were conducted with selected religious leaders, teachers, and health professionals. Quantitative data were analyzed using descriptive statistics in SPSS, and qualitative data were analyzed thematically. The analysis focused on SBCC awareness, communication trust, message channels, and perceived barriers to implementation. Results Sixty-eight percent of respondents reported awareness of SBCC or related community awareness activities, while 32% reported limited or no awareness. Religious leaders were the most trusted communication source (47%), followed by community elders (19%), health workers (17%), teachers (10%), and media actors (7%). Radio (38%) and mosque sermons (33%) were identified as the most effective channels, while social media (17%) and community meetings (12%) were also important. Key barriers included low literacy (29%), cultural misconceptions (26%), limited media access (24%), and insufficient SBCC training (21%). Conclusion The findings suggest that SBCC in Somalia is most effective when embedded within trusted community structures and linked to routine health-promotion systems. A combined model that integrates religious leadership, community elders, health workers, radio, mosque-based communication, and digital platforms may strengthen public trust, improve message acceptance, and support positive health-related behavior change. Institutionalizing SBCC within primary health care, maternal and child health, vaccination, school health, and community resilience programs is recommended.