designing for behavior change

Designing for Behavior Change

Lael Kucera, Program Advisor for Hygiene & Sanitation

Living Water International

Accord WASH Summit // November 6, 2014

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


The success of your programs depends on participants adopting positive behaviors.


It’s about action–DOING–not just beliefs and knowledge.

Behavior Change Strategy

It flows through every sector.

The DBC Framework Evidence-based

Structured & systematic Focuses on specific behaviors

& priority groups Identifies motivators & barriers

Quick, cheap, & flexible

To promote this behavior...

...among this audience...

...we will focus on these

determinants...

...and promote these bridges to

activities...

...by implementing

these activities.

The DBC Framework

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. 

Behavior Priority & Influencing Group Descriptions

Significant Determinants

Bridges to Activities Activities

What is the specific, measurable, observable, feasible action to be promoted?

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.




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?

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.

Priority Group Description

Overcome food insecurity and have a healthy life with healthy children. Like being appreciated by others.

Daily Activities

Common Desires

Demographics

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.

Priority Group Description

Most of the priority group wash their hands with soap and water regularly at some of the five critical moments.

Perception (what do they know, feel, & do related to the behavior?)

Stage of Change

Barriers




Perform a Barrier Analysis to discover the Significant Determinants from among 12 common determinants of behavior change.

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

“I don’t know how to clean the water filter.”

a. Neg. consequence b. Perceived risk c. Culture

a. Social norms b. Pos. consequence c. Perc. severity

a. Access b. Self-efficacy c. God’s will.

“It’s our tradition to drink water from the lake.”

“Building a latrine will make my wife happy.”

Barrier Analysis Survey

90 Structured Interviews 45 “Doers”

45 “Non-doers” Mix of open- and closed-ended questions

Write statement

Develop questionnaire

Train data collectors

Collect data Analyze data

Barrier Analysis Survey




One “Bridge to Activity” for each Significant Determinant.




The Activities that will result in ACTION by the Priority Group (habits)

Significant Determinants Bridges to Activities Activities

1. Perceived positive consequences I wash my hands with soap and water at critical times to protect my children from diseases.

1. Increase the perception that washing hands with soap and water by moms at the five critical times protects their children 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.’


2. Perceived susceptibility/risk Unlikely that I or my children will get diarrhea in the coming weeks if I wash my hands with soap and water at the five critical times.

2. Increase the perception that it’s very unlikely for children and adults to get diarrhea if they wash their hands with water and soap at the 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)


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.



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.

Implement, monitor, evaluate Share, learn, and scale!

What’s next?

COMMENTS QUESTIONS

designing for behavior change

Government & Nonprofit