Planning Behaviour Change: Chances and Challenges

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WASH 2011 conference: Dr. Christine Sijbesma, IRC

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  • 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.
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Planning Behaviour Change: Chances and Challenges

    1. 1. Planning Behaviour Change: <br />Chances and Challenges<br />Dr. Christine Sijbesma, IRC<br />1<br />Illustration: NEWAH, Nepal<br />
    2. 2. Why plan to promote good practices?<br /><ul><li>Sewerage can cost as much as US$ 270</li></ul> per Disability-Adjusted Life Year averted<br /><ul><li> Piped house connections cost US$ 223
    3. 3. A hand pumps program costs US$ 94
    4. 4. Promoting basic sanitation costs US$ 11
    5. 5. Promoting hygiene costs < US$ 5</li></ul>2<br />Session 1A2C – Planning for sustainable behaviour change<br />
    6. 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)<br />Session 1A2C – Planning for sustainable behaviour change<br />3<br />
    7. 7. But: Impacts on health need a CRITICAL MASS of good practices! <br />4<br />Session 1A2C – Planning for sustainable behaviour change<br />
    8. 8. Practical Planning Tool: FOAMS (adjusted from WSP)<br />5<br />
    9. 9. Focus practices WHAT to practice?<br />Handwashing + soap lessens diarrhoea 45%, ARI 23%, neonatal death 40-44% . Substitutes also work (Hoque et al, 1995)<br />2) Toilet use ->32% lower diarrhoea <br /> (WHO, 2008)<br />Safe drinking water chain management : 35-47% reduction diarrhoea (UNICEF, 2008) <br />Under-researched: infants’ faecal-oral chain management <br />6<br />
    10. 10. Focus Groups : WHO to practice?<br />HWWS: esp. caregivers of children under five (mothers/grandparents) and birth attendants <br />Toilets: men, children under 12 and adolescent boys ‘ since women, adolescent girls use most<br />Safe drinking water chain management – source to cup: women primary role , men gender support role <br />Under-researched: caregivers infants’ faecal-oral chain management (Cairncross et al 2010)<br />Session 1A2C – Planning for sustainable behaviour change<br />7<br />
    11. 11. Opportunity: WHEN can practice?<br />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 blindness<br />8<br />Session 1A2C – Planning for sustainable behaviour change<br />
    12. 12. Ability: How will they practice?<br />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 <br />9<br />Session 1A2C – Planning for sustainable behaviour change<br />
    13. 13. Motivation: WHY practice?<br />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 messages<br />10<br />Session 1A2C – Planning for sustainable behaviour change<br />
    14. 14. Sustained: HOW LONG is practice?<br />Comparative study in six countries:<br /><ul><li> After 1 year only 1 of 17 practices had faded
    15. 15. At longer interval 2 of 25 dropped significantly
    16. 16. Access to water made no difference
    17. 17. Better educated women= better practice
    18. 18. In India men sustained HWWS and toilet </li></ul> use less than women, yet most programs <br /> targeted women<br />SEUF<br />11<br />
    19. 19. Five key lessons <br />FOAMS analysis of cases at Hygiene Workshop Melbourne 2010 :<br />Know your Focus Groups<br />Prioritise Focus practices and avoid overload<br />Ensure Opportunity for change at community & institutional level<br />Motivate good behaviours through all drivers. Health is “Mekka”, but many roads lead to it - Health goal itself is seldom a strong trigger<br />Determine if practice is Sustained <br />12<br />Session 1A2C – Planning for sustainable behaviour change<br />

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