Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

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  • F H Mughal
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Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

While at the 6th World Water Forum, Marseille, in March this year, I attended an interesting side-event on behaviour change in sanitation and hygiene, convened by the Global Community of Practice on Sanitation and Hygiene and WSSCC. The event was moderated by Pippa Scott of WSSCC. The session was a free debate on what works and doesn’t work in changing behaviors for sanitation and hygiene. The session was attended by 31 participants from 14 countries. The following was the interesting output of the frank discussions:

What works in changing behaviors?

• Targeted interventions (what incentives and messages work in a given context?)and discover the key points of change, what is the crucial “tipping point” for target groups (i.e. privacy for girls in Cambodia). Targeting children to take the messages to
elders.
• Repetition so that practice comes behaviour
• Incentives, positive reinforcements, aspiration (self worth, dignity, motivation)
• Self-realization and discovery, strong emotions, personal competition, peer
pressure.
• Product placement and branding (marketing for social change)
• Improving user experiences (make it enjoyable, uplifting, cool!)
• Try everything that works, respond to the situation with flexibility. Use not only one
approach, but try different approaches and broaden out.

What doesn’t work in changing behaviors?

• Health messages, they are too abstract
• Don’t ask anyone to change behavior that you want, generate self-realization
• Creating user experiences in poor conditions is difficult
• Tragedy of promise EXAMPLE: from Uganda, shared handwashing basin by public
latrines is not refilled because people don’t want to use clean water to fill a basin
for collective use for handwashing, water is perceived as too
precious for that.

Anyone interested in adding more points; or, may like to share some personal experience on changing behaviors.

F H Mughal
F H Mughal (Mr.)
Karachi, Pakistan
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  • AnanyaGh
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Hi,
This is a nicely framed and comprehensive write up on behavior change. The output is really interesting and true to the grass-root real sense!
Thanks for sharing,
-Ananya
Wash-in-Schools
'Learner'
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Dear Ms. Ananya,

Thank you for your nice comments. This is the first response I got after nearly 8 months. Thanks anyway!

For some reasons, not known to me, hygiene and behavior change aspects receive relatively low priority on this forum. My nearly 40 years' of experience in WASH tells me that the benefits of safe water and appropriate sanitation cannot be fully achieved, in absence of the hygiene aspect. Hygiene goes hand in hand with water and sanitation. To incorporate hygiene, behavior change is required.

This is an important forum and, hygiene and behavior change should receive high priority.

Perhaps, Dr. Elisabeth, Christian, and Trevor may look into this and, come up with some suggestions. The least Dr. Elisabeth, et al. can do is to collect hygiene and behavior change publications, worldwide and, disseminate them through this forum.

Regards,

F H Mughal
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Hi Mr. Mughal,

I work in Wash United, India. As per your comment, yes, both are related topics and we have been organizing regular Skype calls in our office with Behavior Change experts all over the world to dive deeper into the aspect. We, in Wash United, believe in using positive triggers. Thus, instead of triggers such as 'shame' and 'disgust', we believe in using games and cultural media for Behavior Change.

The issue of Hygiene, Sanitation and the change of Behavior is like fighting out a deep-rooted king-sized demon. Publications on Behavior Change would surely be a great help in this fight towards a clean world.

Thank you for bringing up the topic.

-Ananya
Wash-in-Schools
'Learner'
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Hi All,

Super-excited to meet you guys on this forum!! I came across this model on Behaviour Change and thought of sharing with you all. This can be applied to a mass as well as an individual. The examples may not be from the WASH sector, but they can always be applied to any sector where the interventions are planned to change a particular behavior. We had a skype call with Ms. Val. Curtis and that was the eye-opener for me.

The TransTheoretical Model talks about a few stages in which behavior can be categorized and reached:

- Precontemplation (Not Ready) - "People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic"

- Contemplation (Getting Ready) - "People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions"

- Preparation (Ready) - "People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change"

- Action – "People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours"

- Maintenance – "People have been able to sustain action for a while and are working to prevent relapse"

Thus, for a community where there has been no interventions can be termed as 'virgin' and is in the first phase of Precontemplation. When most people in a community know the problem - they are in the contemplation phase. When they know the problem and want to take action, they are said to be in the "Preparation" phase and needs just a spark to help them move to the next level of "Action".. and so on.

Thus, before planning the interventions for any issue, we should first know about the stage at which the community exits. Then, plan the interventions accordingly. Suppose, say, the community is not even aware of the problem, then the intervention should be so planned, that they can be made aware and moved to the stage of Contemplation. Again, if the community is at the stage of contemplation and is aware of the issue/problem, then the intervention should be so planned in such a way to move towards the next stage of Preparation and consequent Action, then towards Maintenance.. and so on.. Thus, this model can be used for any issue, provided we know our target population well.. And the issue can be ranging from quitting of smoking or WASH behavior or for that matter ANY sort of Change of Behavior to be planned.

Some people believe (obviously without any proof), that this model is borrowed from Maslow's Hierarchy model. However, what I am concerned about, is whether this model is applicable to the WASH sector. Thoughts?


Cheers,

-Ananya
Wash-in-Schools
'Learner'
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Dear Ms. Ananya,

Thank you for bringing up this model. It looks very interesting. I too would like to see its applicability in WASH sector. Perhaps, you can contact WaterAid office in India. They are well-placed to conduct research, and assess its applicability in WASH sector.

In any case, please share any further progress or research that you may have on this forum. Dr. Val Curtis is a great name in WASH sector.

Regards,

F H Mughal
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Karachi, Pakistan
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  • sjoerdnienhuys
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Hi, Mughal, I missed your 2012 contribution.
In a Pakistan/Tajikistan project I worked in, the behaviour change was planned according to four basis steps: Information, Awareness, Motivation and Action.
Although many projects focus on Information, it is not always translated into Action. In sanitation we used a combination of health information with cost-benefits especially when related to the cost of poor sanitation related diseases that are commonly known by the users such as diarrhoea and intestinal worms and related (repeated) medical costs as well as loss of energy. This seemed an important trigger for the more intelligent people. Once the intelligent people (being usually the richer and most influential ones) adopted other/better sanitation standards, others followed. This is known as the neighbour effect, as well as doing/copying what the rich people do (status).
Another economic link was the possibility of obtaining safe quality fertilizer from the dry-composting latrines, since the purchasing of fertilizer is rather expensive. Also in this case there was a relation with the economics and health (better household foodsupply).
Cost, status, quality and benefit are therefore two important triggers that need to be interwoven with the other elements to obtain a succesful change.
Sjoerd from The Netherlands.
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Dear Mr. Sjoerd,

Thank you for your prompt response. It is great to see that you worked in Pakistan.
Yes, I fully agree with you. In sanitation, I have seen 2 factors, that trigger some action, are the diseases associated with poor sanitation and the expenses incurred on the medical bills; and the cost of sanitation hardwares.

Thank you for bringing this up.

Regards,

F H Mughal
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Karachi, Pakistan
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Hi Agnes,

We are involved in Wash-in-schools and we use games in this process of triggering.
I liked the idea of the adaptation of the SLTS/CLTS approach into the process that you have started with SWASH! However, I am keen to know more on the 3rd and the 4th point that you have mentioned:

"3.discovery of home to school linkages which can ensure use and maintanance of
SWASH facilities
4.school pupils competition on SWASH issues to encourage peer learning"

Can you please elaborate on these? I would like to know the ways/interventions taken by you for peer learning and ensuring of O&M.

Cheer,

-Ananya
Wash-in-Schools
'Learner'
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  • Tumaini
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Wow! Sanitation activists,
What a touching true theme you had on behaviour change; "using a toilet is harder than quitting smoking".I am in a discussion with the sanitation team on how to keep the ball rolling on SWASH (School Water, Sanitation & Hygiene) intervention which involved strong emotions triggering:
1.showing how teachers eat feaces of pupils while marking their note books
2.self realization of how budget holders ignore improvement of School WASH facilities
3.discovery of home to school linkages which can ensure use and maintanance of
SWASH facilities
4.school pupils competition on SWASH issues to encourage peer learning
We really have a long way to go but we have no reason to sitback and silence while our health is in the hands of good hygienic behaviour.
Agnes! +255 713619531
Advisor-Water,Sanitation & Hygiene
Arusha-Tanzania
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

In Tajikistan one MSDSP supported school received a new UD composting toilet and developed a drama play related to improved sanitation. The issue was that at toilets were of bead quality.
The play as I recall:
"A family discussed what to do with the money from the harvest. The father wants a newer car, the mother a larger TV, the oldest son a motorcycle, the oldest daughter an IPod, but the youngest daughter wants a better toilet because they have one at school. The youngest son needs to go to the toilet and the youngest daughter helps him about. Because of the rotten planks, the kid falls in the pit and needs to be cleaned and his wounds dressed. After that he get very ill with diarrhoea and cold fever and needs docter attention, injections, medicines and a lot of expenses are incurred.
After this ordeal there is little money left, but they all decide now that it is better to build a new modern composting toilet so they no longer suffer diseases and have fertilizer as well."
The play was highly successfull in changing peoples minds about toilets.
Sjoerd from The Netherlands.
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Re: Behaviour change in sanitation and hygiene - 'You thought quitting smoking was hard - try using a toilet'

Dear Ananya,
With home to school linkage we carry out coaching of village leaders and school committees(these compose of community and school representatives) on accountability relationships to make SWASH shines.
Under school pupils competitions, pupils show their cases on SWASH messages and facilities made out of their innovations, then pupils are given rewards for motivation.
Some of the events will be shared in later stages

Kind regards,
Agnes!
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