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Engaging stakeholders
in the development of a Theory of Change
to support a systematic review aimed at WASH
(Water, Sanita...
I have no actual or potential conflict
of interest in relation to this
presentation.
Project is funded by
Name Affiliation Role, area of expertise
Karin Hannes Faculty of Social Sciences,
Catholic University of Leuven,
Belgium
E...
Theory of change?
✚An ongoing process of reflection
to explore change and how it
happens – and what that means
in a partic...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
Intention to
practice
handwashing
and
sanitation
interventions
(readi...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
...
Intermediate outcomes
Longer-term
outcomes
Education
INTENTION
USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDG...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDG...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDG...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDG...
Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
...
Conclusions and next steps
✚ Discussion with the different stakeholders resulted in
a ToC that is more relevant to our tar...
More information?
✚ Protocol of our mixed-methods SR:
registered in Campbell Library (http://bit.ly/2eNfVCn)
✚ Webpages at...
Acknowledgements
Questions?
Suggestions?
Remarks?
ToC is based on…
1. WASH behavioural models
• RANAS model as a basis: intermediate outcomes,
contextual factors
• IBM-WASH...
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Engaging stakeholders in the development of a Theory of Change

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Engaging stakeholders in the development of a Theory of Change to support a systematic review aimed at WASH (Water, Sanitation, Hygiene) policy makers

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Engaging stakeholders in the development of a Theory of Change

  1. 1. Engaging stakeholders in the development of a Theory of Change to support a systematic review aimed at WASH (Water, Sanitation, Hygiene) policy makers Hans Van Remoortel, Emmy De Buck, Axel Vande Veegaete, Philippe Vandekerckhove, Taryn Young
  2. 2. I have no actual or potential conflict of interest in relation to this presentation. Project is funded by
  3. 3. Name Affiliation Role, area of expertise Karin Hannes Faculty of Social Sciences, Catholic University of Leuven, Belgium Expert qualitative research Hans-Joachim Mosler EAWAG, Environmental Social Sciences, Switzerland WASH behaviour change expert Colex Chapendeka Red Cross Malawi MSc in WatSan, WatSan expert and PHAST trainer Alfonso Alvestegui UNICEF Mozambique Water and Environmental Sanitation Specialist, Small Towns WASH Programme Manager Brian Kae Enriquez Red Cross Philippines Expert WASH software approaches, IFRC Asia Pacific Zone Harun Jojo British Red Cross WatSan expert, Public health engineer Chaitali Chattopadhyay WSSCC Funding agency
  4. 4. Theory of change? ✚An ongoing process of reflection to explore change and how it happens – and what that means in a particular context, sector, and/or group of people • Contains hypothesized causal links • Short versus intermediate versus longer- term outcomes • Possible effect of positive/negative mediators or moderators
  5. 5. Intermediate outcomes Longer-term outcomes EDUCATION Intention to practice handwashing and sanitation interventions (readiness, willingness) Use: uptake, adherence, and longer- term use of/to handwashing and sanitation activities (latrine use, faeces disposal,…) Habit to practice handwashing and sanitation interventions (routinized behaviour) Knowledge concerning sanitation and handwashing program Skills concerning sanitation and handwashing program Attitude concerning sanitation and handwashing program Norms concerning sanitation and handwashing program Self- regulation concerning sanitation and handwashing program BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context: dignity/respect, culture, religion, ethnicity, law/regulation, socioeconomic status/authority/role model, minorities, social capital, information environment, division of labour Recipients physical context: place of residence (rural vs urban), low vs middle income countries, natural and built environment ((quality/maintenance of) infrastructure, geophysical), safety, remote areas, available space Recipients personal context: demographic variables (age, gender, race, cast, language, education, occupation), physical health, mental health Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality
  6. 6. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context: dignity/respect, culture, religion, ethnicity, law/regulation, socioeconomic status/authority/role model, minorities, social capital, information environment, division of labour Recipients physical context: place of residence (rural vs urban), low vs middle income countries, natural and built environment ((quality/maintenance of) infrastructure, geophysical), safety, remote areas, available space Recipients personal context: demographic variables (age, gender, race, cast, language, education, occupation), physical health, mental health Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality
  7. 7. Intermediate outcomes Longer-term outcomes Education INTENTION USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population(Elements of) promotional approach Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality Layer 1: Promotional approaches Refining the definition of promotional approaches aimed at handwashing and sanitation behaviour change Stakeholder involvement
  8. 8. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE: UPTAKE VS ADHERENCE VS LONGER- TERM USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality Layer 2: Short-term, intermediate and longer- term outcomes 1. creating an additional outcome layer with short-term outcomes, 2. Better defining the intermediate outcome “use” 3. clear distinction between program outputs and outcomes
  9. 9. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE: UPTAKE VS ADHERENCE VS LONGER- TERM USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality Layer 2: Short-term, intermediate and longer-term outcomes 1. creating an additional outcome layer with short-term outcomes, 2. Better defining the intermediate outcome “use” 3. clear distinction between program outputs and outcomes
  10. 10. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE: UPTAKE VS ADHERENCE VS LONGER- TERM USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality Layer 2: Short-term, intermediate and longer- term outcomes 1. creating an additional outcome layer with short-term outcomes, 2. Better defining the intermediate outcome “use” 3. clear distinction between program outputs and outcomes
  11. 11. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE: UPTAKE VS ADHERENCE VS LONGER- TERM USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality Layer 3: Factors influencing the implementation 1. completed and clarified a list of contextual factors 2. added a layer of “recipient-related factors” 3. added a layer of “program environment factors”
  12. 12. Intermediate outcomes Longer-term outcomes EDUCATION INTENTION USE HABIT KNOWLEDGE SKILLS ATTITUDE NORMS SELF- REGULATION BEHAVIOUR CHANGE: Short-term outcomes Psychosocial theories Community- based participatory approaches Marketing approaches Incentives Advocacy Target population Process evaluation factors: -recruitment -attrition -reach -dose -fidelity -adaptation -engagement -satisfaction -acceptability (Elements of) promotional approach Outputs Potential Influencing factors Program environment factors: -training/qualifications of implementers -leadership of implementing organization -(adapted) training materials -partnership, coordination between providers of same intervention or other health interventions -funding -contextual factors implementers (e.g. gender) -intent of program to change a specific outcome Recipient-related factors: -awareness of personal risk -self-efficacy -awareness about costs and benefits -public commitment -others showing behaviour -planning skills Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients :personal context (e.g. demographic variables (gender)) Other promotional elements such as the use of pride and disgust, behaviour change techniques,… Morbidity,Mortality
  13. 13. Conclusions and next steps ✚ Discussion with the different stakeholders resulted in a ToC that is more relevant to our target groups ✚ Stakeholder involvement in the ToC development created a sense of ownership and stakeholder buy-in ✚ ToC will be used as a central thread during the development of a systematic review (SR) + will be further refined with findings from the SR ✚ Theory-based approach will help policy makers to understand the important role of implementation, and the processes determining behaviour change in handwashing and sanitation
  14. 14. More information? ✚ Protocol of our mixed-methods SR: registered in Campbell Library (http://bit.ly/2eNfVCn) ✚ Webpages at Belgian Red Cross website (http://bit.ly/2emJk50) ✚ cebap@redcross.be ✚ http://bit.ly/2epYjbp ✚ @CEBaP_evidence
  15. 15. Acknowledgements
  16. 16. Questions? Suggestions? Remarks?
  17. 17. ToC is based on… 1. WASH behavioural models • RANAS model as a basis: intermediate outcomes, contextual factors • IBM-WASH model: some additional contextual factors 2. PROGRESS framework: additional items for the contextual factors 3. Checklist for implementation & SURE framework: selection of factors playing a role in implementation 4. Phase 1 of the project: overview of existing systematic reviews 5. Stakeholder consultation (face-to-face meeting Cape Town)

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