Planning Behaviour Change: Chances and Challenges
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This document discusses planning for sustainable behavior change in hygiene practices. It notes that hygiene improvements like promoting handwashing are extremely cost-effective public health interventions. However, impacts on health require a critical mass of people adopting good practices. The document introduces the FOAMS planning tool - focusing on identifying the key practices to promote, groups to target, opportunities and abilities for people to adopt practices, their motivations, and sustaining practices long-term. It emphasizes the importance of formative research to understand these factors and plan effective behavior change programs tailored to different communities.
Planning Behaviour Change: Chances and Challenges
- 1. Planning Behaviour Change: Chances and ChallengesDr. Christine Sijbesma, IRC1Illustration: NEWAH, Nepal
- 2. Why plan to promote good practices?Sewerage can cost as much as US$ 270 per Disability-Adjusted Life Year averted Piped house connections cost US$ 223
- 3. A hand pumps program costs US$ 94
- 4. Promoting basic sanitation costs US$ 11
- 5. Promoting hygiene costs < US$ 52Session 1A2C – Planning for sustainable behaviour change
- 6. “In places with poor water supply, sanitation & hygiene, basic public health interventions are extremely cost-effective, and hygiene improvements most of all” (Jamison et al, 2006)Session 1A2C – Planning for sustainable behaviour change3
- 7. But: Impacts on health need a CRITICAL MASS of good practices! 4Session 1A2C – Planning for sustainable behaviour change
- 8. Practical Planning Tool: FOAMS (adjusted from WSP)5
- 9. Focus practices WHAT to practice?Handwashing + soap lessens diarrhoea 45%, ARI 23%, neonatal death 40-44% . Substitutes also work (Hoque et al, 1995)2) Toilet use ->32% lower diarrhoea (WHO, 2008)Safe drinking water chain management : 35-47% reduction diarrhoea (UNICEF, 2008) Under-researched: infants’ faecal-oral chain management 6
- 10. Focus Groups : WHO to practice?HWWS: esp. caregivers of children under five (mothers/grandparents) and birth attendants Toilets: men, children under 12 and adolescent boys ‘ since women, adolescent girls use mostSafe drinking water chain management – source to cup: women primary role , men gender support role Under-researched: caregivers infants’ faecal-oral chain management (Cairncross et al 2010)Session 1A2C – Planning for sustainable behaviour change7
- 11. Opportunity: WHEN can practice?Good promotion program, with own objectives, budget, staff, skills? Necessities to practice present (e.g. water, soap)? Social/gender relations enable practice? E.g. in water-scarce area in Tanzania mothers-in-law & husbands did not allow extra water use to wash children’s faces to prevent eye infections and blindness8Session 1A2C – Planning for sustainable behaviour change
- 12. Ability: How will they practice?Do people have the required time, money, equipment ( or alternatives ) time, skills, knowledge to practice? E.g. handwashing by pouring instead of in same bowl, with women and young children (who have most risks) last in hierarchy 9Session 1A2C – Planning for sustainable behaviour change
- 13. Motivation: WHY practice?What triggers certain groups to adopt certain practices? E.g. in Niger, 36 reasons for toilet use, 1 was better health.... Mostly socio-cultural & economic: convenience, privacy, safety, status (e.g. ‘star’ home in Sri Lanka), time saving, witchcraft prevention Different groups have different triggers, so formative research is needed to plan effective messages10Session 1A2C – Planning for sustainable behaviour change
- 14. Sustained: HOW LONG is practice?Comparative study in six countries: After 1 year only 1 of 17 practices had faded
- 15. At longer interval 2 of 25 dropped significantly
- 16. Access to water made no difference
- 17. Better educated women= better practice
- 18. In India men sustained HWWS and toilet use less than women, yet most programs targeted womenSEUF11
- 19. Five key lessons FOAMS analysis of cases at Hygiene Workshop Melbourne 2010 :Know your Focus GroupsPrioritise Focus practices and avoid overloadEnsure Opportunity for change at community & institutional levelMotivate good behaviours through all drivers. Health is “Mekka”, but many roads lead to it - Health goal itself is seldom a strong triggerDetermine if practice is Sustained 12Session 1A2C – Planning for sustainable behaviour change
Editor's Notes
- #3: DALY= The sum of all future years of life lost when a baby, young, or more mature person dies prematurely, PLUS all the years of productive life lost due to a person’s disability.
- #4: Bartram J, Cairncross S (2010) Hygiene, Sanitation, and Water: Laxminarayan R, Chow J, Shahid-Salles SA (2006) Intervention Cost-Effectiveness: Overview of Main Messages. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington DC: The World Bank. pp. 35–86. see also: Forgotten Foundations of Health. PLoS Med 7(11): e1000367. doi:10.1371/journal.pmed.1000367
- #6: References FOAM (without S): Coombes, Y.; Devine, J. (2008). Introducing FOAM : a framework to analyze handwashing behaviors to design effective handwashing programs : global scaling up handwashing project. Washington, DC, USA, Water and Sanitation Program, WSPNguyen, N.K.; South Asia Hygiene Practitioners Workshop . Designing evidence-based communications programs to promote handwashing with soap in Vietnam : paper presented at the South Asia Hygiene Practitioners Workshop, Dhaka, Bangladesh, 1 to 4 February 2010 . http://www.irc.nl/page/51638
- #7: Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: costs, benefits and sustainability ofinterventions to protect and promote health. World Health Organization, Geneva, 2008.WHO, 2008. Fewtrell et al., 2005 and Clasen 2006 in UNICEF 2008, http://www.unicef.org/wash/files/Scaling_up_HWTS_Jan_25th_with_comments.pdfHoque B A et al, 1995. Post-defecation handwashing in bangladesh: Practiceand efficiency perspectives Public Health, Vol.109, Issue 1 , Pages 15-24, http://www.publichealthjrnl.com/article/S0033-3506(95)80071-9/abstract
- #8: Women and girls already motivated; groups to convince are men (and women more influence on programs, so that sanitation and hygiene make it onto local development agenda Cairncross: Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010) Hygiene, Sanitation, and Water: What Needs to Be Done? PLoS Med 7(11): e1000365. doi:10.1371/journal.pmed.1000365
- #9: Women and girls already motivated; groups to convince are men (and women more influence on programs, so that sanitation and hygiene make it onto local development agenda Cairncross: Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010) Hygiene, Sanitation, and Water: What Needs to Be Done? PLoS Med 7(11): e1000365. doi:10.1371/journal.pmed.1000365Mc Cauley et al in Wijk, Christine van Wijk and Tineke Murre (1995). Motivating better hygiene behaviour. Importance for public health. Mechanisms for change . New York, USA: UNICEF. http://www.unicef.org/wash/files/behav.pdf
- #10: Women and girls already motivated; groups to convince are men (and women more influence on programs, so that sanitation and hygiene make it onto local development agenda Cairncross: Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010) Hygiene, Sanitation, and Water: What Needs to Be Done? PLoS Med 7(11): e1000365. doi:10.1371/journal.pmed.1000365