Influencing Household Water

Treatment Behaviors:

What We’ve Learned

Cecilia Kwak

Population Services International

• Programs use multiple communications channels to relay different aspects of messages & determinants

• Mass media: Broad-reaching communications

Radio, TV, print ads,

national campaigns

• Targeted communications

Community outreach,

peer educators,

street theater

influential leaders

Evolving communications is key to HWT

behavior change

PSI Behavior Change Model

Trends in Key Determinants of

Adopting HWT Behaviors

Significant Predictors of Water Treatment

Household surveys across 15 countries

Those who treat water with POU vs. those who do not treat water with POU

Range of behavioral determinants

Significant predictors of HWT practices across countries Social Support / Social Norms

Self-Efficacy

Perceived Availability

Perceived Threat / Perceived Susceptibility**

Perceived Availability of Products

PERCEIVED AVAILABILITY

“Where I live there are vendors that sell WaterGuard”

“I know where to obtain WaterGuard”

“I can find WaterGuard within 30 minutes of where I live”

(PSI Sudan 2010 TRaC Survey)

SELF-EFFICACY

Self-efficacy

I am confident to be able to

use all necessary materials to

treat water with WaterGuard”

I can take the required time to

treat water using WaterGuard

I think it is easy to use

WaterGuard

I can easily follow

WaterGuard instructions

POU Water

Treatment:

As Easy As

“1, 2, 3”

Social Norms and Social Support

• My neighbors take some

action to treat their water

to make it safer to drink

• The majority of people in

my village take some

action to treat their water

to make it safer to drink

Product Demonstration Teams:

Allow Trial and Error and Build Confidence

and Trust in POU

• Tanzania –

demonstration team

(nurses at health center)

PHOTO

• Malawi or Kenya – CBD

demonstration teams

(including handwashing

demo teams) PHOTO

The role of cholera control in initiating social

support of POU practices

“Caution! Cholera and

Typhoid kill. If you suffer

any of the symptoms visit

your doctor immediately.”

This message is brought to you

by the Ministry of Health

Perceived Risk / Susceptibility

2008 PSI Kenya Campaign:

Linda Kila Tone, “Guard Every Drop”

2007 Kenya: WaterGuard, the “caring

protector” that every mother needs

Zimbabwe: Introducing POU in the midst of

cholera

• PSI Zimbabwe’s Safe Water program was launched in 2008 before the cholera outbreak.

• First cholera outbreak in August 2008

– Spread to 56 of 62 districts

– >91,000 cumulative cases

• Program focus in cholera-reported areas; currently national scale

• Communications to promote hand washing, water treatment and IPC through xx partners

• Availability of water purification productsDemonstrate that water purification tablets are always easy to find and available within walking distance from their home

• Social supportEncourage assistance on use of water purification tablets as provided by partners, family members and friends

• BeliefsIncrease beliefs that water purification tablets kill all the germs in water and treating water makes the water safe to drink.

Safe Water System Program

Cholera outbreaks bring out immediate

support for water treatment

Demonstration of water treatment and correct withdrawal of water at a

community event, outskirts of Harare, Zimbabwe, 2009.

PSI/ Z in Action

Musicians take part in a cholera campaign in Harare

Social Support: My family, my neighbors treat their

drinking water

Social Support: My family, my neighbors treat their

drinking water

0.3%

26.2%

36.8%

14.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2008 National Survey 2009 National Survey 2009 - Exposed to Communications

2009 - Not Exposed to Communications

Current Use of Water Treatment among HHs with children under 5, 2008 - 2009 by Exposure to Communications

2008 National Survey

2009 National Survey

2009 - Exposed to Communications

2009 - Not Exposed to Communications

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Availability*** Social Norms*** Self Efficacy to treat water***

Social Support***

Mean

Sco

res (

Ou

t o

f 5)

PSI Messages Addressed Key Determinants and Led to Increased Use of Water Treatment

2008 Baseline

2009 Non-Exposed

2009 Exposed

Note:

***p<.001

Lessons Learned

There are patterns among factors that drive POU

behaviors

Drivers of POU behaviors are often outside of the

individual sphere of influence

Need to contextualize behavioral determinants

Engagement around POU due to emergency

response is an important entry point

Measuring / evaluating is complex