Key Concepts

• Social and behaviour change is complex and affected by a variety of factors that operate at several, intertwined levels: individual, interpersonal, community and societal. It is important to focus on all these levels in a WASH or outbreak control programme (chapter  A , chapter  P  and chapter  E ).

• A variety of theories exist to explain what motivates behaviour and behaviour change. They include psychological theories that consider cognitive factors (such as attitudes, norms and self-efficacy) and models which look at change within the context of society B.2. 

• All the theories underline the importance of understanding the barriers and motivators T.3 that influence people’s behaviours by conducting a thorough assessment, rather than relying on assumptions about behaviour (chapter  A ).

• To change behaviour, the most influential motivators and barriers must be targeted through specific activities, often called behaviour change techniques (BCTs). A variety of BCTs form the active ingredients of behaviour change interventions. 

• Behaviour change approaches (B.8 and chapter  F ) generally explain how theories and formative research can be used to design an effective behaviour change programme. They may provide a menu of activities along with guidance for selecting the most appropriate approach in a specific context. 

 

Good Practice

• Define which risky behaviours should be reduced and which protective behaviours should be adopted or increased (A.2 and A.7) as a first step in designing behaviour change interventions. 

• Define who needs to change. In diverse and mixed populations it is essential to describe specifically who needs to change as well as what needs to change (chapter  A , chapter  E  and chapter  C ). 

• Develop a theory of change that defines the programme’s exact activities and behaviour change techniques and describes how these will change the motivators and barriers of each target behaviour. It should include quantifiable indicators of success.

• Use the theory of change (or Logical Framework, T.25) to plan the intervention, describing the chain of actions needed from planned activities through to the intended impact A.9 and outlining how change will be monitored and evaluated (M.2 and M.3). 

• Assess each context and community A.7 and avoid making uninformed assumptions about what will work. An intervention that works well in one specific context might not work in another. Formative research can be used to decide which motivators and barriers to address. This can strengthen the theory of change and enable the intervention to be further tailored to the specific needs and context of the target audience.  

• Challenge misconceptions about the impact of ‘hardware’ on hygiene behaviour – for example, that hygiene infrastructure (P.2, P.3, P.4, P.5) or the supply of hygiene items P.6 is all that is required to trigger and sustain behaviour change. Examples of deserted latrines and soap diverted to household purposes instead of handwashing are good illustrations of this misconception. 

• Pilot hygiene behaviour change interventions during the design process. Behaviour change theories and models B.2 are fallible and it is essential to adapt them if necessary to increase their feasibility and acceptability. 

• Ensure that interventions are monitored and evaluated (chapter  M ) to identify what worked, what did not work (and why) and share the results with other stakeholders, including communities. Feedback Mechanisms T.13 are also needed to understand the perspective of communities.