Step 3 of our three step process for hygiene programme design requires organisations to think about how they will actually bring about behavioural change (i.e. by identifying behaviour change techniques) and how you will reach your target population (i.e. by identifying appropriate delivery channels.
What are behaviour change techniques:
Behaviour Change Techniques (BCTs) are the active ingredients of your project. BCTs focus our attention on the content of what we will do whereas discussion on delivery channels is all about how this will be done. The RANAS model and the COM-B both provide detailed lists of BCTs. Commonly implementing actors struggle to link their formative research findings with BCTs and then develop these into detailed activity descriptions that can be implemented in the programme setting. The following models provide additional guidance on how to make this transition: the RANAS process, Wash’Em and Designing for Behavior Change. The diagram below shows a worked example of how formative research findings on handwashing behaviour are translated into BCTs and BCT are used to develop project activities.
Defining delivery channels:
Work with communities to map out all of the ways you could reach them and share information with them at this time. You can do this through a simple brainstorming exercise as shown in the image below:
Source: Sian White / LSHTM
For a more structured approach try using the Wash’Em ‘Touchpoints tool’ an example of this in action is shown in the video below. Note that this video was taken before COVID-19. To adapt this method you could try conducting online group discussions or you could bring people together in an outdoor space and make sure that physical distancing is maintained during the session and that people wash their hands with soap before and after the session .
When deciding which delivery channels to use consider the following:
- Safety: Use national guidelines to assess whether it will be possible for your staff to use delivery channels which involve in-person interactions. Where possible make sure to include some delivery channels which are non-contact or have minimal contact. Examples include radio, television, social media, printed materials or loudspeaker announcements. Consider how you might adapt your delivery channels at different stages of the outbreak.
- Reach: Which delivery channels are available to the majority of people within your population? If you are considering using mass media, you might also want to pay attention to which stations people tune into and at what times. If you are working in an area where people have access to social media and the internet, find out the websites and social media sites that are most commonly used and trusted and how they are used within the culture.
- Accessibility: While overall reach is important it is necessary to also consider which delivery channels are most appropriate for different sections of the population. Women and girls, older people, people with disabilities, people with pre-existing medical conditions, people living in rural areas, and other vulnerable groups are all likely to be harder to reach through most delivery channels. To overcome these challenges, it may be necessary to actively engage these populations to identify their preferences and tailor materials to their needs. This document from UNICEF provides some guidance on how this can be done for people with disabilities and this document from IFRC provides guidance on engaging and communicating with older people.
- Credibility and trustworthiness: Which communication channels or individuals do people trust or respect? Exploring this with communities may challenge common assumptions about what constitutes reliable public health information. For example, a recent study among Rohingya refugees living in Bangladesh found that trusted sources of information during outbreaks included trained community leaders, such as imams and women’s group leaders. Information from these sources was preferred over health and aid workers who are not always seen as trustworthy and are sometimes misunderstood. Refugees also trusted members of the Rohingya diaspora rather than public health information shared by local news services as Bangladeshi and Burmese news services were seen to stigmatise refugees and even legitimise violence against them. For more information about source credibility see this article.
- Influence and persuasion: Certain delivery channels or sources of information may not be seen as credible or trustworthy but may still be persuasive or influential. For example many people know to question the credibility of information they see on social media. However there are still a whole range of reasons why people might find social media posts influential and persuasive. The persuasiveness of information often depends on it’s design, the content and format (e.g. photos and videos may be more persuasive than text alone), whether the message resonates with your beliefs and values and who the information is shared by within your social network. For more information about persuasion see this resource.
Avoid relying on any one delivery channel. Interventions that use a range of delivery channels to engage and remind populations are typically more successful in changing behaviour. Here are some examples explaining the value of multiple delivery channels: Study 1, Study 2, Study 3.
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 1: Selecting target behaviours, populations and settings
- Step 2: Learning from populations about behavioural barriers & enablers
- Bringing theory, evidence, formative research, BCTs and delivery channels together to design an intervention
- Ongoing adaptation and improvement to hygiene programmes
Author: Sian White