Intentional Intervention Design

WA’s Experiences

Erik Harvey and Om Prasad Gautam WaterAid UK

WA’s hygiene definition: Hygiene refers

to behaviours that encourage the

widespread adoption of good key hygiene

practices in order to keep people and their

environment clean. Sustained hygiene

behaviours enhance dignity, prevent

spread of diseases, reduce under-

nutrition and maintain health.

Hygiene Behaviour Change – WA’s Strategic Focus

Key shift in our hygiene behaviour change work

KNOWLEDGEINFRASTRUCTURE/

PRODUCTS

Rewarding

Routines

Habit formation Changing behavioural settings

Changing scripts – motivations

Encouraging social norms

Behaviour change focus

Our approach: Behaviour Centred DesignHow we design, implement and evaluate our hygiene programme?

Credit: LSHTM/WaterAid, WA has mainstreamed BCD approach

WA’s Focused Multiple Hygiene Behaviours In Different Settings

Handwashing

with soap

Handwashing

with soap

Use of safe

water

Use of clean

toilet

Food

Hygiene

Use of safe

water

Use of clean

toilet

Waste

management

Co

mm

un

ity

sett

ings

Hea

lth

care

set

tin

gs

Campaign inspiration (desire)

Handwashing

with soap

Use of safe

water

Food

Hygiene

Sch

oo

l set

tin

gs

Use of clean

toilet

Menstrual

hygiene Menstrual

hygiene

Food hygiene

and Others

Sustained hygiene practices

What resources we have to facilitate the

formative research and creative process?

10 Countries• Bangladesh

• Nepal

• Pakistan

• Malawi

• Mozambique

6

Recent WA’s examples where

formative research and creative

process completed

• Madagascar

• Tanzania

• Ethiopia

• Ghana

• Mali

• Modules and toolkits • Technical Training and its guide • In-country facilitation

Hygiene MOOC: Feb 2019ABCDE

Formative research: WA’s learnings• An essential steps for creative process

• Key to generate information on: behaviour

and its determinants, motives, barriers,

touch points, supply chain, power

dynamics, socio-cultural variability etc

• Formative research requires more than

interviews and FGDs

• Formative research design is mostly

qualitative

• Need to ensure field team are well trained

and understands the tools

• WA is trying to make FR process simple

and quick with appropriate toolkits for

practitioners to use

• FR and KAP are not similar. Shift in mind-

set and understanding tools takes time

Spot Check Videoing Teach the researcher

Motives and barrier

mappingBehavioural

trial

Touch points

mapping

Observation Narrative scenario

FGDs, in-depth

interview

Microbes

assessment

The creative design process

Implementers

‘Creatives’

Target populatio

n

Behaviourchange

specialists

Public health/ social science

specialistsWorking in a

multidisciplinary team

Key information from FR

Process the information

Play around them and identify ideas

Ranked the ideas

Select the best creative idea after assessing best possible option

Practical steps for creative process: WA’s experience

Identification of insights based on the FR main findings

Develop creative brief, define design principles for intervention and agree on ToC

Design a behaviour change package idea/activities and tools based on the insight (how might we?)

Define behaviour change package rituals, agree on identity, branding and centre inspiration

Define key motivation for each of the target behaviours

Group the intervention ideas into different sessions based on touch points and produce prototype

Pre-testing, finalization and production

Capacity building leading to implementation

Insight:

How might we….

intervention ideas

Tools Touch points

motivate …

change setting

create social norms

INSIGHT (story): Wise men

lead by example, they provide

soap, they build handwashing

facilities near the toilet and

they find creative ways to

encourage other family

members to also wash hands

with soap. They are respected

and role model in society

It takes at least 2-3 months to complete creative process and finalize the package

Creating social norms

(desire for change)

Changing script in

people’s head through

motivations

Changing settings

(disrupting behavioural

setting)

Developing an intervention idea: three keys to consider

Insight:

How might we….

intervention ideas

Tools Touch points

motivate … ? ? ?

change setting

? ? ?

createsocial norms

? ? ?

Identify right activities for 3 keys

Note: fill the gap through the creative process

Creatives: surprising and attractive intervention

GET EXPOSURE GRAB ATTENTION SURPRISE

Revalue behaviours: use multiple motives

ADD NEW MOTIVES

Disgust Status Affiliation

Reward: link with the desire

“Ideal family” campaign

53%

improved 5

key

behaviours

Status anxiety: we want to be an ideal family.

Nudge: instant reminder

7% reduction in

period

prevalence of

diarrhoea

Visual cues, props, and reminders in kitchen

settings and public certification for ideal

family

INTERVENTION BRAIN BEHAVIOUR IMPACTENVIRONMENT

Improve

immunizatio

n coverage

by 10% (95%)

>95% HHs

declared

as ideal

family(as a secondary

outcomes)

(as a primary outcomes)

Child life game, letter exchange, family drama,

hot potato game, programme jingle, folk song, commitments,

public reward, media mobilization, TV show,

Radio and public pressure

Hygiene intervention package into

immunization to expose 5 times

Activities links with: Nurture motives Disgust motives

Affiliation motives Status motives

Leadership from MoH and routine monitoring

Belief in improve trust on immunization, and MoH being role model

Test ideas using theory of change (ToC) - pathways for success(Example: hygiene integration into ongoing immunization programme)

WA’s learnings: creative process• Precise creative brief with summary findings from FR also highlighting the scope that clearly sets out

constraints are needed

• Involve multi-disciplinary creative team / people (a team not necessary from single organization) to

design the hygiene intervention

– Finding all required skill-sets in one organization may be challenging

– Look at previous work, is it surprising, different, and changing behaviours?

– Recognize that creativity costs money. Allocate resource to design the intervention

– Everyone can be creative. Don’t constraint your creative thinking at the beginning

• Design full package (not just one or two activities/tools) for targeted key behaviours under the single

umbrella of behaviour change

• Intervention has to be simple but surprising, creative, acceptable, different and focus on behaviour

change

• Prepare for multiple reverts in your timeline

• Creativity is better when constrained (challenge to creatives)

• Producing prototype package, pre-testing and refining before finalization also takes times

• Contracting takes months

Thank you

15

Q&A

IMPROVING WASH BEHAVIOUR

CHANGE APPROACHES:

16

Practical experiences from the South Asia WASH Results Programme

Mimi Coultas, Plan International UK

Plan International UK 2017 ©

• Background• South Asia WASH Results Programme (SAWRP)

• SAWRP I:• Improving sanitation, hygiene (and limited

water) for 6.6 million people• Rural Pakistan and Bangladesh • Output phase: April 2014 – December 2015• Outcome phase: January 2016 – March 2018

• SAWRP II:• Improving sanitation, hygiene (and limited

water) for 650,000 people• Rural Bangladesh only • Output phase: June 2017 – June 2019• Outcome phase: July 2019 – March 2021

• Payment by results for water, sanitation and hand washing outputs and outcomes

17

Plan International UK 2017 ©

• Behaviour Centred Design• What our process has involved to date

18

Plan International UK 2017 ©

• Where have we got to?• What our package of tools and activities includes

19

• 11 face to face interactions with target groups• 2 community theatre events• 4 courtyard sessions• 2 one to one household support visits• 2 Mosque/Temple sessions• 1 school session

• All materials branded with an overarching logo, tagline and a common song incorporated into each session

• Step by step training and facilitation manuals with accompanying tools

• Focus on interpersonal communications and motivational interviewing throughout

Plan International UK 2017 ©

• Our experience to date• What has worked well

20

• Using BCD as a structured way to challenge assumptions and use evidence to support decisions

• Bringing the whole team on board to ensure continued buy in and relevant feedback

• Developing a clear creative brief to guide the creative agency and having detailed implementation constraints clear from the start to (e.g. budget, staffing, skills, time)

• Allocating time and resources for creative agency to pre-test in the field with frontline staff

• Incorporating feedback from Training of Trainers in final manuals

Plan International UK 2017 ©

• Our experience to date• What has been challenging

21

• Designing for multiple partners, behaviours and geographical areas within programme timeframes

• Confidence• How much is enough? -resources, data, testing• Lack of practical experiences to draw on

• Translation

• Designing the formative research to generate findings that are useful and in a usable format

• Distilling formative research into insights and using these throughout the creative process

• Avoiding reinforcing gender stereotypes

Mimi Coultas, Plan International UKmimi.coultas@plan-uk.org

•Thank•you

Intentional Intervention Design:designing for behavior change impact and scale

30 Oct 2018

Designing the Bauleni Secret Shared Peri-Urban Sanitation

Quality Improvement Interventionusing Behavior Centered Design

James B. (Ben) TidwellPost-Doctoral Research Fellow

Harvard Kennedy School of Government

30 Oct 2018

Model of Behavioral Determinants

Neocortex(thinking, planning,

deciding)

Mammalian(motivation, reward)

Reptilian(instincts, habits)

Behavior Change through Reinforcement

Learning

SurpriseIntervention:

“The Bauleni Secret”

Surprise Revaluation Performance

State of the World:

Better Sanitation

RevaluationIntervention:

“The Bauleni Secret”

Surprise Revaluation Performance

State of the World:

Better Sanitation

PerformanceIntervention:

“The Bauleni Secret”

Surprise Revaluation Performance

State of the World:

Better Sanitation

Using a Design Process

Use of a Creative Agency

Takeaways

• Don’t miss potential drivers of behavior change

• Understand what it takes to change behavior

• Be creative!

• Formative research is a part of a learning paradigm