The ability to perform a behaviour is an important pre-condition for engaging in it. Ability may depend on access to critical infrastructure (P.2, P.3, P.4, P.5 and P.6) or knowledge B.3 and skills. In contrast, self-efficacy relates to confidence in the ability to perform a behaviour. It is a subjective perception and may differ drastically from actual ability. 

In HP programmes, people’s actual ability can be improved through access to WASH facilities and services (chapter  P ). In addition, HP can provide the knowledge and skills to increase ability and overcome internal barriers to change. However, improved knowledge and access does not necessarily increase a person’s subjectively perceived ability to perform a behaviour - known as self-efficacy. For example, despite having all the required knowledge, skills and access to WASH facilities, an individual may still feel unable to perform a critical behaviour because of a previous experience of failure when e.g. using an Oral Rehydration Solution (ORS) to manage diarrhoea, or because they lack the physical capacity to dig a latrine. In such cases, interventions that aim to develop confidence in the behaviour, or that identify community support mechanisms, can effect much more significant behaviour change than infrastructure and education. 

Emotional wellbeing can also significantly affect self-efficacy. Tiredness and hunger, or high levels of stress can impair a person’s ability to make choices or perceive themselves in a positive light. Trauma can be a significant barrier to action.

Process & Good Practice

• Demonstrate and model behaviour and impart skills through peer-to-peer learning: by observing peers demonstrating a behaviour such as hygienic food preparation individuals realise that they can do it too.

• Provide direct guidance: participants are encouraged to practise the behaviour under the direct guidance of a hygiene promoter to directly experience their ability to perform the behaviour.

• Encourage behavioural practice: participants are encouraged to practise the behaviour during their daily life. They can then meet again with the hygiene promoter to discuss how it went.

• Use feedback to strengthen self-efficacy: providing people with encouragement and positive feedback about their ability to perform the behaviour increases self-efficacy. 

• Set graded tasks or goals: some complex behaviours might seem impossible to adopt in a single step. Self-efficacy can be increased by breaking down the new behaviour into smaller, easier tasks (e.g. collecting the items needed to make ORS, making the solution, administering it to a sick child) and providing support at each stage. 

• Re-attribute previous successes and failures: a failure in the past to change or maintain a behaviour may negatively affect self-efficacy. Identifying and discussing what went well, what went wrong and why can bolster self-efficacy.

• Support people to cope with relapse: relapses of behaviour may discourage individuals from continuing with the new behaviour. Informing them that relapse is normal motivates people to try again.

• Enhance ability by ensuring that essential WASH needs are met for all members of the affected population (chapter  A  and chapter  C ). Self-efficacy can depend on contextual factors, in particular, access to WASH facilities and services (P.2, P.3, P.4, P.5 and P.6), as well as the provision of other services. 

• Identify community support mechanisms T.46 where required, to support self-efficacy e.g. to help collect water. 

• Encourage community hygiene promoters to coach and support others through Household Visits T.18 and discussion T.14.