Step 1 of our three step process for hygiene programme design requires clearly defining the behaviours your project intends to focus on. If you are struggling to decide which behaviours to promote, focus on behaviours that have a known public health benefit, that are being recommended or prioritised by the government in your settings, and behaviours that are adapted in such a way that they are feasible to do for populations. Key preventative behaviours for COVID-19 will likely relate to handwashing with soap, cleaning and disinfecting surfaces, physical distancing and mask use. It will be useful to refer back to global and national guidelines during this step.
When defining a behaviour be clear to state who needs to do what, where, when and how. This process is often referred to as segmentation. This means that defining your target behaviour as ‘handwashing with soap’ is not specific enough. Instead definitions for target behaviors, such as handwashing with soap, can be written out as follows:
- Who: All members of the population, including groups like children, people with disabilities, or poorer segments of the population who may find regular hand washing more challenging.
- What: handwashing with soap or alcohol-based hand rub.
- Where: at home and in public locations such as in schools, healthcare settings, marketplaces and religious sites.
- When: At times that are important for interrupting COVID-19 transmission (after coughing or sneezing, when entering or leaving the household or any other building, after coming into physical contact with anyone outside your household, after touching surfaces when outside the home, after visiting a public space such as public transportation hubs, markets and places of worship, and before, during and after care of a sick person) as well as at standard critical times (such as before food preparation, before eating or feeding a child, after using the toilet and after cleaning a child’s bottom).
- How: for at least 20 seconds, rubbing all parts of hands thoroughly and creating a good lather with the soap.
Describe behavioural attributes:
During this stage of programming, it is also useful to define the specific attributes of the target behaviour. Behavioural attributes refers to the characteristics of the behaviour itself. For example:
- Do you want people to practice a behaviour or stop practicing a behaviour?
- Is the behaviour new or unfamiliar?
- Is the behaviour routine or one-off?
- What can be done to make the behaviour feasible in the context?
For handwashing, remember that handwashing is not a new behaviour - most people know or understand how to wash their hands. However, for COVID-19, we may be asking people to wash hands at new times. Handwashing also happens on a regular, routine basis. Handwashing is also dependent on access to infrastructure and supplies. Making handwashing feasible to practice in some contexts may involve looking into low-cost soap options, how to practice handwashing when water is scarce and how to scale-up handwashing infrastructure.
On the other hand, behaviours like physical distancing are new in all cultures and normally require us to stop behaviours that we are used to doing. This requires social norms to be challenged. For example, people around the world are being asked not to hug, kiss or shake hands as part of greetings and instead adopt new, non-contact modes of greeting each other. Safe mask use is another new behaviour in most countries, too. With both of these behaviours, substantial contextualisation may be necessary to make sure these behaviours are feasible to practice in resource limited settings.
Define target audiences and settings:
Many water, sanitation and hygiene projects are designed to reduce diarrhoeal diseases. For this reason key target groups are often caretakers of children under the age of 5. However, everyone is susceptible to COVID-19 and those most at risk of developing serious symptoms are older adults. As such, we need to ensure that the whole population practices key prevention behaviours, including people who feel healthy.
When defining your target audience, it is also important to define the setting where you would like to see changes in behaviours. Many hygiene programmes are targeted at the community level. However if you plan to work in schools, health centres, workplaces or public settings like markets then it is useful to identify this early on as the factors that determine COVID-19 preventative behaviours may be different in each of these settings.
There are several advantages to clearly defining the behaviours, target groups and settings. It will help guide your research and investigation - allowing you to be more aware of potential barriers and enablers. It will also guide which behavioural products are needed to practice behaviours (e.g. for practice handwashing this will may include handwashing facilities, soap, water in key locations). Specificity will also help you communicate clearly to populations and avoid messages that are difficult for populations to act upon (e.g. a message like ‘maintain good hygiene’ is not clear enough to act upon).
Want to know more about the process for designing effective behaviour change projects for COVID-19 prevention?
- Brief overview of the three step process for hygiene programme design
- How to incorporate guidelines, theory and evidence throughout the programme design process
- Step 2: Learning from populations about behavioural barriers & enablers
- Step 3: Identifying appropriate behavioural techniques and delivery channels
- Bringing theory, evidence, formative research, BCTs and delivery channels together to design an intervention
- Ongoing adaptation and improvement to hygiene programmes
Author: Sian White