Hello everyone,

Nivedita has raised some practical points that we will take forward into the discussion on ODF and slippage.

I will prepare a summary of these discussions on 'sustainability for behaviour change' in the coming days. Please do watch this space!

Kind regards,

Tracey

Hi Everyone,
I am Nivedita,working with Urban Management Centre (UMC) from past Three months. UMC work with local government in improving sanitation conditions. Now days we are working on Dahegam city located in Gandhinagar District of Gujarat state. We are working on its slums and slum like settlements for improving their sanitation facilities. It is often seen that slum dwellers don't use available toilet facility due to cultural habits. But in case of this city it has been observed that households which are connected to sewer system are using the toilet facility in slums.
But in case of households having single pit people are reluctant to use it as they are satisfied with the depth of single pit which is 3-5 feet.17% of slum households having single pit, defecate in open. Now single pit system is considered as insanitary toilets where government is trying to change single pit to twin pit. But in case of lack of space twin pit cannot proposed nor is the sewer line coming in those areas in near future. I would like to know other possible options for sanitary toilets that can be provided and also adopted by the users.

Dear all,


As we know, many programmes just jump from behaviour change objectives straight to the activities, without giving much thought to why people do what they currently do and what may be preventing them from adopting the hygiene behaviours promoted. So I would say the key point is to ensure one's activities are based on (1) regular analysis of the barriers and drivers towards behaviour change (through formal barrier analysis methodology or mere group discussions, informal chat and observations);(2) that in answer to the analysis made, new Hygiene promotion campaigns are designed each time that incorporate the information collected ; (3) that a robust M&E system is associated to each new campaign so as to be in position to assess its results in terms of effective behaviour change (and not just improvement in knowledge). The latter is crucial because, - whatever they are - we need to find out whether or not the behaviour change techniques we are using in our particular context of interventions are successful or not (for adjustment if needed). Ex for handwashing: % of people washing their hands with soap when coming out the latrine blocks (for refugee camps for instance), percentage of newly installed handwashing facilities at HH levels, etc.

Amicalement

I know I'm a bit late to this conversation but I read an interesting related study by Whaley & Webster - they compared CLTS to Community Health Clubs approach
www.iwaponline.com/washdev/001/0020/0010020.pdf

"Whilst both approaches effectively encouraged measures that combat open defecation, only health clubs witnessed a significant increase in the adoption of hand washing. However, CLTS proved more effective in promoting latrine construction, suggesting that the emphasis the CHCs place on hygiene practices such as hand washing needs to be coupled with an
even stronger focus on the issue of sanitation brought by CLTS."

Hans - thanks for sharing this presentation. I think it's similar to one I saw you present at the Oklahoma University WaTER conference. Your conclusion is to change behavior, use psychology. I remember thinking then, as I did reading through this presentation - governments and WASH NGOs need new types of people! Or at least new partners.

I'm curious how many WASH implementing organizations have this kind of skill on staff?

Désolé pour le retard de partager l'information en français ...

Pour un changement durable des comportements – Introduction, invitation et questions

Je voudrais vous ramener, juste pour un moment, à la première fois que vous avez pris conscience que vous deviez vous laver les mains avant de manger ou après avoir déféqué. Vous aviez peut-être 5 ans, 15 ans ou 25 ans et on peut supposer qu’une raison vous a poussé à le faire. Alors, réfléchissez... pourquoi l’avez-vous fait ? Un professeur, un membre de la famille ou un ami vous a-t-il dit de le faire ? Quelqu’un vous a-t-il remis un fascicule sur les avantages que cela représentait pour votre santé ? Avez-vous simplement reproduit ce que d’autres faisaient ? Quand est-ce devenu un automatisme ?

N. B. Si vous n’avez aucun souvenir à ce sujet, essayez de penser à un autre comportement ou à une autre pratique que vous avez modifiés dans votre vie. Par exemple, arrêter de fumer, mettre les déchets à la poubelle, faire plus de sport, éteindre la lumière lorsque vous quittez une pièce, etc.

La raison pour laquelle je vous pose ces questions est que je voudrais que vous vous mettiez à la place de quelqu’un dont vous pensez que le comportement doit changer ; pas uniquement dans son intérêt personnel, mais aussi dans celui de la communauté. Mettez-vous à la place de cette personne quelques minutes, comment vous sentiriez-vous ? Comment aimeriez-vous que l’on communique avec vous : par les gestes, la parole, l’éducation ? Par la provocation ou les encouragements ? Comment pourrait-on vous convaincre en cet instant précis ? Il serait difficile de vous faire changer d’avis, n’est-ce pas ?

Cette semaine, nous parlerons des dynamiques ainsi que des normes sociales et comportementales qui influencent nos pratiques en matière d’hygiène, en particulier le lavage des mains et l’utilisation d’installations sanitaires par tous les membres des ménages et par l’ensemble de la communauté.

Les normes sociales sont des valeurs, des croyances, des attitudes et des comportements socialement acceptés ou approuvés – qui traduisent ce qu’une personne considère comme étant le comportement correct que l’on attend d’elle. Cette notion est liée à l’idée que les gens se font du comportement que l’on attend d’eux et à ce que font la plupart des autres gens. (IDS, 2015).

Nous aborderons les processus qui sous-tendent les techniques de changement de comportement, les différentes façons d’appréhender et de faire évoluer les normes sociales et comportementales, ainsi que la façon dont nous pouvons systématiser les approches de changement de comportement. Nous fournirons des documents de référence sur les théories qui sous-tendent le changement de comportement, ainsi que des exemples tirés d’autres secteurs (que WASH). Enfin, nous nous attacherons à partager et à tirer les enseignements des expériences, des connaissances et de l’expertise de chacune et chacun en matière de changement de comportement. (La semaine prochaine, nous étudierons plus en détail les solutions qui s’offrent à nous pour mettre fin à la défécation à l’air libre et empêcher le relâchement.)

Pour entamer la discussion, j’ai demandé à Henrieta Mutsambi, responsable du programme WASH à l’Institut pour le développement de l’eau et de l’assainissement (Institute of Water & Sanitation Development – IWSD) au Zimbabwe de nous faire part de son point de vue (voir billet suivant). Je vous invite également à partager vos expériences et vos idées sur les questions suivantes :

1. Selon vous et d’après votre expérience (et le contexte dans lequel vous travaillez), quelles sont les principales techniques de changement de comportement qui fonctionnent pour intensifier la pratique du lavage des mains et/ou l’utilisation d’installations sanitaires par tous les membres des ménages ?

2. Comment pouvons-nous influencer et modifier de façon durable les normes sociales liées à l’hygiène ? À quelles difficultés avez-vous dû faire face ?

3. Sur quels domaines devons-nous nous pencher et lesquels devons-nous approfondir ?

Je remercie également les membres du Forum SuSanA d’avoir partagé leur approche de la promotion de l’hygiène : Nabil Chemaly pour sa contribution sur le Programme pour l’eau du GIZ au Burundi, ainsi que Franck Flachenberg, conseiller technique en hygiène du milieu chez Concern Worldwide.

Merci.

Tracey

Référence :

Cavill, S. avec Chambers, R. et Vernon, N. (2015) « Durabilité et ATPC : État des lieux », Aux Frontières de l’ATPC : Innovations et Impressions n° 4, Brighton : IDS.

www.communityledtotalsanitation.org/reso...t-atpc-tat-des-lieux

www.communityledtotalsanitation.org/site...%C3%A9_et_ATPC_0.pdf

Hi everyone, there have been additional inputs into this discussion from the WSSCC CoP. I've copied the messages for your consideration:

From Takudzwa Noel Mushamba:

Thank you Tracey for the insightful discussion. I am a Zimbabwean graduate student based in Turkey. I am an engineer by profession I worked in Zimbabwe and Namibia. I am not an expert in behaviour change regardless associating and working in various WASH projects. I am going to comment as an engineer and a person who grew up in a peri urban area (Epworth, no piped water, poverty etc) I am sure you get the picture. As human beings we are programmed or so I believe to behave in a certain manner unless there is a strong reason to change that pattern. Clearly most people have knowledge about hand washing and the risk associated with not doing so. But underlying factors such as the financial status of a household always play a part:

1. Convenience - despite knowing all the risks involved with unclean hands most people are not willing to go through the process of going to get water from a few kilometres away hence i firmly believe a person with piped water in the house has "better chances" of changing or adopting hand washing for example.


2. Absence of cases or low prevalence of water and sanitation diseases is not necessarily and indicator of "improved behaviour". I am sure we all understand the epidemiological triangle (www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf) lets assume I do not wash my hands when I am in Europe. I am sure I have less chances of contracting a disease related to WatSan because of the environment while at the same time it is easy to adopt hand washing because of the convenience and access. I think we are more a product of the environment that what people tell us.

The same message means different things to two people. To one it means open the tap and a hand sanitizer and to another it means buy extra soap travel to a borehole 8 km away and get an extra bucket of water and wash before you eat. Infrastructure plays a huge role not only in reducing exposure but also in fostering new behaviour. Thank you

And from Tom Davis who comments on Jihane's earlier comment:

I think the focus on using paid professionals for health promotion, Jihane, is unfounded. See this paper where we found that projects using Care Groups had double the adoption of HWWS as projects that did not use Care Groups. Care Groups rely on volunteers. www.biomedcentral.com/1471-2458/15/835

Also see the different determinants found for the 18 Barrier Analysis studies on HWWS shown on the Food Security and Nutrition Network's Behavior Bank. www.fsnnetwork.org/behavior-bank.

Thanks for the inputs and your presentation Hans. What I really appreciate about your analysis is the systematic mapping of potential behavioural determinants (based on human psychology) and how they can be practically linked to specific behaviour change technologies. So then, practitioners would be able to develop a tailored, context-specific approach.

Although, as you pointed out, designing those approaches could be better done by engaging with creative agencies - who would also have to understand the context and audience. Regarding your point on how this collaboration could / should be done, several companies (of course, UNILEVER) come to mind that have approached changing hygiene behaviours on a large scale, with the support of such agencies for sure (for example, see www.unilever.com/sustainable-living/the-.../health-and-hygiene/).

Clearly, there's a (potentially controversial) question here about how we engage with the private sector - whether big companies or creative marketing agencies. Beyond that however, what seems important for me is to better understand and learn from their experiences and expertise on the basic mechanisms or structures behind the design of large scale behaviour change media campaigns.*(Ref below) So that those design principles are coherently addressed in the design of our programmes and complement whatever is happening on the ground on personal health education and follow-up.

On the WSSCC CoP, Hanna Woodburn shared with us a blog on what makes WASH behaviours stick (blogs.3ieimpact.org/making-wash-behaviour-stick/). It also links to a 3ie-supported systematic review (available at: www.3ieimpact.org/publications/systemati...ic-review-summary-2/) which found that:

... frequent, personal contact with a health promoter over a period of time is associated with long-term behaviour change. The review suggests that personal follow-up in conjunction with other measures like mass media advertisements or group meetings may further increase sustained adoption.

Having a complementary approach (mass media plus local, sufficiently long-termed support and follow-up) can clearly reap rewards. My question is, how to we systematically plan for that and deliver it in a project or programme cycle? Hygiene behaviour change rarely seems to be elevated to this systematic planning status in WASH programmes - despite our recognition of its importance. It also requires us to work in partnership with others that we may not usually engage with - and we all know how challenging it is to work in partnership .

All this to say that we clearly need to challenge and change our own behaviours and norms that influence our working practices too!

Any thoughts you or colleagues have on this would be welcomed - especially those with examples of where these types of multi-pronged approaches have seen success.

Thanks everyone, Tracey

* UNILEVER design advice for mass media campaigns: www.unilever.com/Images/slp_5-Levers-for...ge_tcm244-414399.pdf

I attended the workshop "Creativity in Behavior Change"* and gave the attached presentation with the title “The RANAS Framework for Systematic Behavior Change”.




It was interesting to see how other researchers as well as practitioners design their interventions and this not only in the WASH sector. We saw several videos of differing appealing degree. A number of specialists from creative agencies presented their approach to design interventions. It seems to be necessary that researchers and creative agencies cooperate in designing effective interventions however it remains undefined how this should be done.

* The Workshop took plane on 23 Sept. 2015 in London UK
Organised by Environmental Health Group - Faculty of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
www.ehg.lshtm.ac.uk





_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Prof. Dr. phil. et dipl. zool.
Hans-Joachim Mosler
Eawag, Environmental Social Sciences
Environmental and Health Psychology
Überlandstrasse 133
CH-8600 Dübendorf / Switzerland

www.eawag.ch/en/department/ess/main-focu...th-psychology-ehpsy/

As stated by WASHHanna motivators are important in behaviour change, applying a mix of different drivers to motivate individuals or even communities to change their behaviours may yield positive results. For example use of shame and affiliation in triggering elimination of open defecation is useful while at the same time incorporating the social cultural triggers in the community.

While working with project officers in Papua New Guinea we also learnt that behaviour change is difficult if not accompanied by infrastructure. Promoting hand washing with water and soap in a community that still uses traditional sources of water such as dug wells that are seasonal, may not be effective because most people will prioritise other household needs. Also, communities that practice open defecation do not practice hand washing because the bushes are located far from the same traditional water sources.

Another Challenge, many local NGO interventions are project based (1 to 2 years) which limits the amount of time spent in the communities. Monitoring behaviour change becomes constrained by resources and project implementation activities/steps/cycle.

Maybe behaviour change should also apply to those responsible for WASH interventions - state and non state actors, to change the way we engage with communities in addition to focusing on the individual practising the risky behaviour

Thanks, Tracey, for your work kicking off this conversation.

I just got back to D.C. after a week in New York for meetings around the UN General Assembly. Many of the events I attended were on implementing the 17 new Global Goals, and when behavior change was mentioned as being key to achieving these goals responses were often abstract. I don't need to tell you all that it is clear just how challenging behavior change is!

And yet, if we hope to have sustainability in our programs, and indeed make a dent on achieving the Global Goals, we must address actually changing behavior.

Through our Handwashing Behavior Change Think Tanks, the Global Public-Private Partnership for Handwashing works to take stock of the best, articulate the gaps, and identify the way forward for hygiene behavior change. Our last Think Tank, held at AfricaSan4 in Dakar, Senegal looked at three big ideas in hygiene behavior change: emotional motivators, behavioral settings, and the science of habit. You can find a brief summary here: globalhandwashing.org/learn/key-topics/think-tank/. I think that the lessons we have learned in each of these areas are applicable to other categories of behavior change. Would you agree?

We've also received a couple more comments today on the WSSCC CoP about Franck's contribution at: forum.susana.org/forum/categories/212-th...trategy-for-hp#15138

Jihane Rangama noted:

I couldn't agree more with Frank's comment. I would add that in a lot of WASH programmes, especially in Western Africa (and Burkina Faso, where I work), hygiene promotion activities such as awareness door-to-door, are performed by local volunteers (members of local women's associations for example). Those volunteers first receive a basic training on hygiene promotion, and then we expect from them to dedicate a few hours a week for several months to deliver hygiene promotion messages to the community. However, many projects feedbacks showed that the volunteers's motivation to perform the HP activities decreased pretty quickly, and the results in terms of behaviour change interventions were not as good as expected. In conclusion, I strongly believe that one of a key to conceive an efficient and sustainable behaviour change campaign is to rely on paid professional workers dedicated to one targeted behaviour.

Samantha French added:

Franck, your comments and Strategy make perfect sense. I think a multi pronged approach is critical as people respond in very different ways. What you have said about igniting an emotional response that trigger the desire for change reminds me of the debates we were having at WaterAid when developing the new global strategy, in which hygiene behaviour change features as a global aim. The demand and desire needs to be created, presumably through the different approaches you have mentioned. Cross sector integration is also key so that schools, health centres, midwives etc all reinforce the same messages.