Designing for Behavior Change
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The document emphasizes the importance of behavior change in health programs, particularly focusing on handwashing among mothers of children under five in rural Haiti. It outlines a behavior change framework that identifies specific motivators and barriers, providing actionable strategies to promote handwashing at critical times. Key activities include sensitization campaigns, reminders, and community engagement to increase awareness and adoption of positive behaviors.
Designing for Behavior Change
- 1. Designing for Behavior Change Lael Kucera, Program Advisor for Hygiene & Sanitation Living Water International Accord WASH Summit // November 6, 2014
- 2. Why Change Behavior? I do not understand what I do. For what I want to do I do not do, but what I hate to do, I do. ~Romans 7:15
- 3. Why Change Behavior? The success of your programs depends on participants adopting positive behaviors.
- 4. Why Change Behavior? It’s about action–DOING–not just beliefs and knowledge.
- 5. Behavior Change Strategy It flows through every sector.
- 6. The DBC Framework Evidence-based Structured & systematic Focuses on specific behaviors & priority groups Identifies motivators & barriers Quick, cheap, & flexible
- 7. To promote this behavior... ...among this audience... The DBC Framework ...we will focus on these determinants... ...and promote these bridges to activities... ...by implementing these activities. Definitions of… Priority Group Influencing Group(s) Perceptions of… Self-efficacy Access Social norms Severity +/- Consequences Divine will Action efficacy Culture Policy Reminders Risk Bridges to activities… 1. 2. 3. Activities… 1. 2. 3.
- 8. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities What is the specific, measurable, observable, feasible action to be promoted?
- 9. Mothers with children under five years old wash their hands with water and soap at the five critical times every day—after defecation, after changing babies’ diapers, before preparing food, before eating, and before feeding children.
- 10. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities Who is the Priority Group with whom we want to facilitate behavior change? What Influencing Groups do your Priority Group say are important in helping them adopt new behaviors?
- 11. Priority Group Description Mothers of children aged 0 to 5 years. Low income. Creole speaking. Reside in rural areas of Haiti. Daily schedule is overloaded (collect water early in the morning, gather firewood, prepare breakfast, lunch, dinner). During the rainy season, help husbands in farming activities. Overcome food insecurity and have a healthy life with healthy children. Like being appreciated by others. Demographics Daily Activities Common Desires
- 12. Priority Group Description They know hand washing can protect against diarrhea but don’t know to what extent. They think it’s God’s will their children get diarrhea. They are aware of the positives consequences of hand washing but often overlook it. Most of the priority group wash their hands with soap and water regularly at some of the five critical moments. Barriers Perception (what do they know, feel, & do related to the behavior?) Stage of Change
- 13. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities Perform a Barrier Analysis to discover the Significant Determinants from among 12 common determinants of behavior change.
- 14. Determinants of Behavior 1. Cues for action (reminders) 2. Perceived negative consequences 3. Perceived positive consequences 4. Perceived social norms 5. Perceived self-efficacy/skills 6. Perceived access 7. Culture 8. Perception of divine will 9. Policy 10. Perceived severity 11. Perceived risk 12. Perceived action efficacy
- 15. “I don’t know how to clean the water filter.” a. Access b. Self-efficacy c. God’s will. a. Neg. consequence b. Perceived risk c. Culture a. Social norms b. Pos. consequence c. Perc. severity “It’s our tradition to drink water from the lake.” “Building a latrine will make my wife happy.”
- 17. 90 Structured Interviews 45 “Doers” 45 “Non-doers” Mix of open- and closed-ended questions
- 18. Barrier Analysis Survey Write statement Develop questionnaire Train data collectors Analyze data Collect data
- 19. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities One “Bridge to Activity” for each Significant Determinant.
- 20. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities The Activities that will result in ACTION by the Priority Group (habits)
- 21. Significant Determinants Bridges to Activities Activities 1. Perceived positive 1. Increase the consequences perception that washing I wash my hands with hands with soap and soap and water at water by moms at the critical times to protect five critical times my children from protects their children diseases. from diseases. 1.1 Organize a sensitization caravan for moms on ‘Hand washing is our Shield.’ 1.2 Produce a script for mothers’ group opinion leaders. 1.3 Organize household mini- drama ‘Clean Hand and Dirty Hand.’
- 22. Significant Determinants Bridges to Activities Activities 2. Perceived 2. Increase the susceptibility/risk perception that it’s very Unlikely that I or my unlikely for children and children will get diarrhea adults to get diarrhea if in the coming weeks if I they wash their hands wash my hands with with water and soap at soap and water at the the five critical times. five critical times. 2.1 Organize a radio debate on the topic ‘Diarrhea is Dangerous’. 2.2 Trigger hand washing using ‘Shit and Shake’ tool ( UNICEF Hand washing triggering tool)
- 23. Significant Determinants Bridges to Activities Activities 3. Cues for action/ reminders I know but I often forget to wash my hands with soap and water-particularly before preparing food. 3. Increase the ability of moms to remember to wash their hands with soap and water before preparing food. 3.1 Produce reminder cards and/or posters on hand washing with soap and water before preparing food. 3.2 Teach moms a catchy song about remembering to wash hands with soap/water before preparing food.
- 24. Behavior Priority & Influencing Group Descriptions Significant Determinants Bridges to Activities Activities Mothers with children under five years old wash their hands with water and soap at the five critical times every day Mothers of children age 0-5yrs. Low income, Creole speaking in rural Haiti. Daily activity overloaded with chores. Desire to overcome food insecurity, and want healthy family. Broad understanding of hand washing. God’s will children get ill. Aware of hand washing. 1. Perceived consequences “I wash my hands at critical times to protect children.” 1. Increase perception hand washing with soap & water by moms at critical times protects children 1.1 Organize sensitization for moms on Handwashing is our Shield.” 1.2 Organize household mini-drama “Clean Hands & Dirty Hands.” 2. Perceived susceptibility “Unlikely that my children will get diarrhea in next 3 months if I wash my hands with soap & water.” 2. Increase perception it is very unlikely for children adults to get diarrhea if they wash hands 2.1 Organize debate Diarrhea is dangerous.” 2.2 Trigger hand washing “Shit and Shake” tool. 3. Cues for action “I know but I often overlook before preparing food.” 3. Increase the ability of moms to remember to wash hands before preparing food. 3.1 Reminder cards for moms. 3.2 Teach moms a song.
- 25. What’s next? Implement, monitor, evaluate Share, learn, and scale!