Changing Behavior - For Real

Sanitation and hygiene are very much about behavior. RWSSP-WN II is sharpening its approach by making our behavior change programme more systematic and based on science.  From May 17 to 20, 2017, RWSSP-WN held a behavior change course to introduce our staff and partners to new behavior change insights and approaches. Over the past two decades, behavioral scientists have gained important new insights into why we behave in the ways we do and what it is that influences our behavior. Their insights are gradually and radically transforming the way we think about behavior and how we go about behavior change, including within the field of WASH.

The four-day course focused on two novel approaches within WASH: a) the RANAS model for behavior change and b) nudging for habit change (Mosler & Contzen, 2016; Neal et al, 2016; Neal et al, 2015). Twenty-five staff members, government partners, and staff members from the Rural Village Water Resources Management Project (RVWRMP) participated in the course.

Days 1-3: RANAS Model of Behavior Change

The RANAS model was developed by Professor Hans-Joachim Mosler at the Swiss Federal Institute of Aquatic Science and Technology. At the heart of RANAS is the idea that psychosocial factors steer our behavior. The model lays out eighteen psychosocial factors that may influence behaviour and organizes them into five factor categories: risk, attitudes, norms, ability, and self-regulation (see figure 1). For example, our use of a toilet might be influenced by what we see or perceive others around us to be doing (this RANAS factor is called Others’ behavior). Another central idea is that specific behavior change techniques (BCT) can and should be used to influence specific psychosocial factors (see figure 1).

Figure 1 RANAS model of behavior change. The blue column contains behavior steering factors. The purple boxes show types of behavior change techniques (BCT) with arrows pointing to the types of behavior steering each BCT type can best be used to address.

The RANAS model lays out a structured four-phase process for how to 1) identify the behavior steering factors by comparing Doers and Non-doers of a desired behavior, 2) find the most appropriate BTCs, 3) design behavior change strategies, and 4) measure change.

The course covered the first three of the four phases. The participants were divided into four groups and each group chose a focal behavior. The behaviors chosen were:

• Use of diapers for children under two years of age

• Boiling of drinking water

• Use of latrine

• Handwashing with soap before preparing food

Each group worked to identify the behavior steering factors, BCTs, and design behavior change strategies for their focal behavior through a series of activities. The activities allowed the participants to put their new knowledge to immediate use and reflect on WASH and behavior change in a new way. There were lively discussions and a lot of lessons learned along the way.

Day 4: Nudging for Habit Change

The final day of the workshop, we focused on habit change in WASH. A ‘habit’ is a learned, automatic behavior, which we perform in response to specific context cues (physical setting, preceding actions, time of day, etc.). Many WASH behaviors – such as handwashing with soap at specific times and drinking water treatment – are habits. Building desirable habits – or breaking undesirable ones – requires a strategy that goes beyond knowledge and motivation (Neal et al, 2016). 

Though knowledge and motivation can play a critical role in bringing a person to try out a new behavior – or abandon an existing one – a habit strategy is needed to make sure that the change sticks over time. During the final day of the workshop, participants were introduced to principles for habit change in WASH. After an overview of principles, each group developed a habit strategy for their target behavior. Two of the habit strategies that the groups developed are shown in figures 2 and 3.

Figure 2 Habit strategy for boiling of drinking water
 

Read more about “Nudging and Habit Change for Open Defecation” and “Creating Sticky and Disruptive Behavior Change in Handwashing Behavior.”

Figure 3 Habit strategy for toilet use, for the elderly

Lessons Learned

• The group activities for each RANAS were critical to give participants a good understanding of the RANAS concepts and behavior change strategy design process. It is essential to set aside enough time for the groups to discuss and learn together in these activities.

• The first step in RANAS - breaking the target behavior into preparatory actions and actions to perform the behavior – was an eye-opening exercise. Seemingly simple behaviors – such as ‘use a toilet for defecation’ – required a lot of discussion to agree on a definition.

• The clearer you can define your target behavior and target group from the beginning, the easier and more efficient the RANAS process becomes. Also, a clear target behavior and target population is necessary to end up with a strong behavior change strategy.

• Self-regulation factors were new to most participants and it quickly became clear that we had given little conscious attention to them in our behavior change efforts. Yet, self-regulation – such as planning and remembering – is often critical to adopt and stick with a new behavior. The course gave us an opportunity to consider self-regulation and plan for how to use it in our work.

• With the RANAS tools, participants analyzed RWSSP-WN and RVWRMP’s existing behavior change work. They found that we already use many BCTs, but that we tend to focus on risk, attitudes, and norms. With RANAS tools, we can be more strategic about how we use BCTs and make sure all types of behavior steering factors are considered.

• In contrast to RANAS – which took a lot of time to grasp –the habit change principles were relatively easy for participants to understand and apply.  The groups were quick to add habit strategies to their existing behavior change strategies.

What Happens Next?

As next steps, the RWSSP-WN will work to have RANAS and the habit change principles inform their behavior change efforts in each district in the next fiscal year. The strategy to do so will be two-pronged. First, RANAS will be fully applied in Kapilvastu district to identify the behavior steering factors, most appropriate BCTs, and design behavior change strategies for two behaviors (toilet use, connecting to a water scheme). Second, all WASH advisors will use the RANAS model and habit change principles to strengthen their behavior change activities in the coming year. What this means is a) that we will focus on changing one or a few behaviors at a time, b) we will consider all risk, attitude, norm, ability, and self-regulation factors for each of the behavior we aim to change, and c) we will include habit strategy where relevant.

REFERENCES

Cavin, V. (2017). Behavior Change Manual. HELVETAS Swiss Intercooperation, eawag, USAid, Tops Small Grant. 35 pages + 12 Annexes

Mosler, H.-J., & Contzen, N. (2016). Systematic behavior change in water, sanitation and hygiene. A practical guide using the RANAS approach. Version 1.1. Dübendorf, Switzerland: Eawag.

Neal, D., Vujcic, J., Burns, R., Wood, W., & Devine, J. (2016). Nudging and habit change for open defecation: New tactics from behavioral science. Water and Sanitation Program. Washington, DC: World Bank Group.

Neal D., Vujcic, J., Hernandez, O., & Wood, W. (2015). The Science of Habit: Creating Disruptive and Sticky Behavior Change in Handwashing Behavior. Washington D.C., USA. USAID/WASHplus Project.

Nguyen, N.K. & Gurung, H. (2015). Barriers and Facilitators to Hygienic Use and Maintenance of Latrines and Handwashing with Soap in Sarlahi, Mahottari, Siraha and Saptari Districts of the Terai, Nepal. Formative Research, SNV WASH Nepal.

SNV (2016). Behaviour Change Communication Guidelines. Sustainable Sanitation & Hygiene for All. SNV WASH Bhutan.

WANT TO LEARN MORE?

Gautam, Omprasad (2015). Food hygiene intervention to improve foodhygiene behaviours, and reduce food contamination in Nepal: an ex-ploratory trial. PhD thesis, London School of Hygiene & TropicalMedicine. DOI: 10.17037/PUBS.02531624

There is a wealth of interesting books available on human behavior and decision making that you can read to find inspiration. If you are interested in learning more, I highly recommend the following – generally easy to read and entertaining – books:

Ariely, Dan. 2010. Predictably Irrational: The Hidden Forces that Shape Our Decisions. Link to book; link to book summary.

Cialdini, Robert. B. 1984. Influence: The Psychology of Persuasion.

Kahneman, D. 2011. Thinking fast and slow. Note: This book is not as easy a read as the other books on the list.

Mullainathan, Sendhil & Shafir, Elder. 2014. Scarcity: The True Cost of Not Having Enough.

TALKS AND PRESENTATIONS AVAILABLE ON THE INTERNET

Scarcity: Why Having Too Little Means So Much. Presentation by Sendhil Mullainathan and Eldar Shafir at the Aspen Institute in 2013.

Predictably irrational – basic human motivation. TED talk by Dan Ariely.

Wendy Wood talk on the science of habit – more academic than the other talks listed.