Delivered by Lael Kucera of Living Water International, this presentation looks at the importance of integrating a behavior change strategy within hygiene and sanitation programs, introduces the Design for Behavior Change framework, and examines the 5 components of the behavior change tool with illustrations.

1. Designing for Behavior Change
Lael Kucera,
Program Advisor for Hygiene & Sanitation
Living Water International
Accord WASH Summit // November 6, 2014

2. 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

3. Why Change Behavior?
The success of your programs
depends on participants
adopting positive behaviors.

4. Why Change Behavior?
It’s about action–DOING–not
just beliefs and knowledge.

5. Behavior Change Strategy
It flows through every sector.

6. The DBC Framework
Evidence-based
Structured & systematic
Focuses on specific behaviors
& priority groups
Identifies motivators & barriers
Quick, cheap, & flexible

7. To promote this
behavior...
...among this
audience...
The DBC Framework
...we will focus
on these
determinants...
...and promote
these bridges to
activities...
...by
implementing
these activities.
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.

8. Behavior Priority & Influencing
Group Descriptions
Significant
Determinants
Bridges to Activities Activities
What is the specific,
measurable, observable,
feasible action to be
promoted?

9. 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.

10. Behavior Priority & Influencing
Group Descriptions
Significant
Determinants
Bridges to Activities Activities
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?

11. Priority Group Description
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.
Overcome food insecurity and have a healthy life with
healthy children. Like being appreciated by others.
Demographics
Daily
Activities
Common
Desires

12. Priority Group Description
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.
Most of the priority group wash their hands with soap and
water regularly at some of the five critical moments.
Barriers
Perception
(what do they know, feel, &
do related to the behavior?)
Stage of
Change

13. Behavior Priority & Influencing
Group Descriptions
Significant
Determinants
Bridges to Activities Activities
Perform a Barrier Analysis
to discover the Significant
Determinants from among
12 common determinants of
behavior change.

14. 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

15. “I don’t know how to clean
the water filter.”
a. Access
b. Self-efficacy
c. God’s will.
a. Neg. consequence
b. Perceived risk
c. Culture
a. Social norms
b. Pos. consequence
c. Perc. severity
“It’s our tradition to drink
water from the lake.”
“Building a latrine will
make my wife happy.”

16. Barrier Analysis Survey

17. 90 Structured Interviews
45 “Doers”
45 “Non-doers”
Mix of open- and closed-ended questions

18. Barrier Analysis Survey
Write
statement
Develop
questionnaire
Train data
collectors
Analyze data Collect data

19. Behavior Priority & Influencing
Group Descriptions
Significant
Determinants
Bridges to Activities Activities
One “Bridge to Activity”
for each Significant
Determinant.

20. Behavior Priority & Influencing
Group Descriptions
Significant
Determinants
Bridges to Activities Activities
The Activities that will
result in ACTION by the
Priority Group (habits)

21. Significant Determinants Bridges to Activities Activities
1. Perceived positive
1. Increase the
consequences
perception that washing
I wash my hands with
hands with soap and
soap and water at
water by moms at the
critical times to protect
five critical times
my children from
protects their children
diseases.
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.’

22. Significant Determinants Bridges to Activities Activities
2. Perceived
2. Increase the
susceptibility/risk
perception that it’s very
Unlikely that I or my
unlikely for children and
children will get diarrhea
adults to get diarrhea if
in the coming weeks if I
they wash their hands
wash my hands with
with water and soap at
soap and water at the
the five critical times.
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)

23. Significant Determinants Bridges to Activities Activities
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.

24. Behavior Priority & Influencing
Group Descriptions
Significant Determinants Bridges to Activities Activities
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.

25. What’s next?
Implement, monitor, evaluate
Share, learn, and scale!

26. COMMENTS
QUESTIONS