Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) is a practical approach for the development of behaviour change interventions that are evidence-based and tailored to the population. The heart of the approach is a set of behavioural factors (motivators/barriers) that determine a behaviour and are grouped into risks, attitudes, norms, abilities and self-regulation factors.

The RANAS approach follows four steps that can be adapted to a context, response phase or WASH and environmental-related behaviour. The behavioural factors of the RANAS approach are: Risk factors describing the perceived risks of contracting a disease and the perceived impact on daily lives. Attitude factors include the perceived costs and benefits related to the target behaviour and the positive or negative feelings connected with it. Norm factors describe the social pressure someone experiences from influential others (e.g. religious leaders) and the social environment (e.g. family members). Ability factors describe an individual’s confidence to perform the behaviour and maintain it even if problems arise. Finally, the Self-Regulation factors describe the strength of an individual’s intention to perform the behaviour, even if there are conflicting goals. Factors include remembering to perform the behaviour, action planning and action control as well as barrier planning. The four RANAS steps are:

Step 1 – Identify Factors: using short qualitative interviews, the main psychological Barriers and Motivators T.3 relating to a target behaviour are identified along with the enabling or hindering contextual factors and characteristics of the current practices and target group. 

Step 2 - Measure: depending on the response phase - but especially in stabilisation and recovery - the information from step 1 is translated into a quantitative questionnaire used to conduct approximately 150-200 household interviews. The questionnaire assesses all the RANAS factors. People who practise a specific behaviour can then be compared to those who do not (Doer/Non-Doer Analysis, T.32). Thus, RANAS factors that are most likely to influence people’s behaviour in a specific context can then be identified. 

Step 3 – Select Technique: for each factor identified in Step 2, a Behaviour Change Technique (BCT) is selected using the online RANAS BCT catalogue. BCTs are based on well-established evidence from scientific research. The selected BCTs are combined to become a single campaign. The corresponding IEC T.19 materials are then developed.

Step 4 - Implement: the campaign is implemented, monitored M.2 and evaluated M.3. The evaluation contributes to an understanding of whether people have changed their behaviour and why - what has changed in their minds, attitudes, feelings and beliefs that has led (or not) to behaviour change? This should lead to adaptations and improvements of the campaign.  

Tools and Methods used

Potential Assessment Tools

• Assessment Checklist T.2
• Barrier and Motivator Analysis T.3
• Focus Group Discussion T.14
• Household Visit T.18
• Key Informant Interview T.23
• Observation T.28
• Positive Deviancy and Doers/Non-Doers Analysis T.32
• Stakeholder Mapping T.49
• Transect Walks T.52

Potential Behaviour Change Tools

• Beautification T.4
• Routine Planning and Self-Regulation T.42
• Involvement of Local Champions (T.22]
• Public Commitments [T.37)
• Rewards and Incentives T.40
• Social Support T.46
• WASH Committees T.55
• Supervised Handwashing T.50
• IEC Materials T.19

Applicability

The RANAS approach can be used in all contexts (urban, rural, camp or host communities) and in all response phases, but so far has mainly been applied in stabilisation and recovery phases. If resources are very limited, the quantitative surveys can be omitted and only qualitative interviews used. It is possible that the RANAS approach could be applied in the acute phase of the response if hygiene promoters are already familiar with it or if expertise can be rapidly sourced. Once piloted, the RANAS behaviour change campaign can be replicated in the same context and scaled up. 

Main Requirements / Investments Needed

Adequate numbers of trained personnel are needed to conduct interviews and data analysis, as well as design and later implement behaviour change interventions. Depending on the available human resources, the RANAS approach can be implemented in between two and four weeks. Training must be provided to the campaign data collectors and hygiene promoters as RANAS BCTs may be new even to experienced hygiene promoters.

Evidence of Effectiveness

The effectiveness of the RANAS approach has been reported in more than 40 peer-reviewed scientific articles. For example, in the Rohingya refugee response, the approach led to a 43% increase in habitual handwashing with soap, 34% more women having access to private spaces for MHM, an additional 37% of households drinking safe water, 70% less littering and an increase of 48% in latrines observed as clean.

Do

• Do carefully read the methodology and develop context-specific tools

• Select BCTs and design a behaviour change campaign that is appropriate for the context

Don't

• Do not fall back into teaching about health risks when people already have this knowledge. Instead, include BCTs that make use of other determinants of hygiene behaviour such as social norms and emotions.

Practical Example

In the Rohingya refugee communities in Bangladesh, UNICEF and its partners implemented the RANAS approach to develop BCTs for eleven different hygiene behaviours. During steps one and two, qualitative interviews identified potential factors which were then tested in a quantitative survey of 400 people. The factors influencing latrine cleaning, for example, were identified by comparing the doers and non-doers. During step three BCTs were selected from the RANAS catalogue according to the key factors identified. The BCTs of ‘Presentation of facts’, ‘Prompting to talk to others’ and ‘Describing feelings about positive consequences’ were employed in user group meetings where doers talked to non-doers. In the same meetings, health promoters asked people to demonstrate latrine cleaning (‘Prompt behavioural practice’) and facilitated the development of detailed cleaning action plans (‘Prompt specific planning’) and discussed solutions to challenges (‘Prompt coping with barriers’). In step 4 the interventions were evaluated using a survey of the same households to identify the positive changes in behaviour.