Application of the Behaviour-Centred Design to Understand Handwashing Behaviors
The Behaviour-Centred Design Approach to Improving Handwashing Practices
Handwashing with soap is one of the most effective ways to prevent the spread of infectious diseases, yet it remains a challenge to implement consistently in many communities around the world. The Behaviour-Centred Design (BCD) approach offers a comprehensive framework for understanding the factors that influence handwashing behaviors and designing effective interventions to drive sustainable change.
Grounding Behavior Change in Behavioral Science
The BCD approach is founded on the principles of evolutionary psychology, reinforcement learning theory, and behavior settings theory. It recognizes that human behavior is the result of a dynamic interplay between our physical and social environments, our cognitive processes, and our innate motivational drivers.
Reinforcement Learning and the Evolutionary Basis of Behavior
At the core of the BCD theory of change is the concept of reinforcement learning (RL). RL explains how our brains use feedback from interactions with the environment to shape our future behaviors. Behaviors that are positively reinforced through rewards tend to be repeated, while those that lead to negative consequences are less likely to be performed again.
From an evolutionary perspective, our behaviors have been shaped over time to maximize our chances of survival and reproduction. Certain behaviors, like handwashing, may not have been directly selected for, but they can provide indirect benefits that improve our overall fitness. However, the modern environment in which we live often presents a mismatch between our evolved behaviors and the optimal behaviors for health and wellbeing.
The Three Levels of Behavioral Control
The BCD framework recognizes three distinct levels of behavioral control, each of which must be considered when designing effective interventions:
- Reactive Control: Our automatic, habitual responses to environmental cues. Habits like handwashing routines fall under this category.
- Motivated Control: Our goal-directed behaviors driven by innate motivational systems, such as the desire to avoid disease (the “Disgust” motive) or the need for social acceptance (the “Affiliation” motive).
- Executive Control: Our conscious, deliberative decision-making processes, which can be influenced through education and planning.
By understanding how these different levels of behavioral control interact, the BCD approach can target interventions to the specific mechanisms driving (or hindering) the target behavior.
Applying the BCD Approach to Handwashing Promotion
The BCD framework outlines a five-step process for designing effective behavior change interventions:
- Assess: Gather information about the target behavior, its determinants, and the context in which it occurs.
- Build: Conduct formative research to fill in knowledge gaps and refine the hypothetical theory of change.
- Create: Develop creative intervention concepts that leverage the insights from the Assess and Build stages.
- Deliver: Implement the intervention and monitor its delivery.
- Evaluate: Assess the outcomes and process of the intervention, using the theory of change as a guiding framework.
Let’s consider how this process might be applied to a handwashing promotion program:
Assess: The first step would be to clearly define the target handwashing behaviors (e.g., handwashing with soap after using the toilet, before preparing food), and gather information on the current handwashing practices, barriers, and motivators within the target community. This could involve reviewing existing literature, conducting observations, and speaking with community members.
Build: The formative research stage would dive deeper into understanding the specific determinants of handwashing behavior in the local context. This might include exploring the physical environment (e.g., availability of handwashing facilities), social norms, individual motivations, and cognitive factors that influence handwashing practices.
Create: Armed with a robust understanding of the target behaviors and their drivers, the next step would be to design creative, theory-based intervention concepts. These could leverage reactive triggers (e.g., eye-catching handwashing reminders), motivational reframing (e.g., associating handwashing with social status or nurturing behavior), and executive planning (e.g., goal-setting exercises).
Deliver: The intervention would then be implemented, with close attention paid to ensuring fidelity to the original design and monitoring of key process indicators.
Evaluate: Finally, the intervention’s outcomes would be assessed, both in terms of changes in handwashing behaviors and the underlying mechanisms of change. This evaluation would not only determine the intervention’s impact but also generate valuable learnings to inform future programs.
The Impact of BCD-Informed Handwashing Interventions
The BCD approach has been applied to handwashing promotion programs in diverse settings, with impressive results. For example, the “SuperAmma” intervention in rural India used a combination of motivational and environmental triggers to increase handwashing with soap from near-absence to sustained practice in nearly one-third of the target population.
Similarly, the “Komboni Housewives” campaign in Zambia leveraged social norms and emotional appeals to drive improvements in handwashing, oral rehydration, and exclusive breastfeeding behaviors. And in Nepal, the food hygiene project used a variety of BCD-informed strategies, including “ideal mother” recognition and kitchen makeover parties, to promote safe food handling practices.
These examples demonstrate the power of the BCD approach to unlock sustainable behavior change by tackling the complex, multifaceted drivers of human behavior. By grounding interventions in the latest behavioral science and design thinking, the BCD framework can help water, sanitation, and hygiene (WASH) practitioners develop innovative, effective, and context-appropriate solutions to improve handwashing and other critical health behaviors.
Conclusion: Towards an Applied Science of Behavior Change
The Behaviour-Centred Design approach represents a significant advance in the field of behavior change, offering a comprehensive and theoretically-grounded framework for designing, implementing, and evaluating interventions. As the global community continues to grapple with pressing public health challenges, the application of BCD principles can help unlock the behavioral insights needed to drive sustainable improvements in handwashing and other essential WASH practices.
By blending the latest developments in behavioral science with best practices in program design and evaluation, the BCD approach is well-positioned to become the foundation for a truly applied science of behavior change. As practitioners and researchers continue to explore and refine this powerful methodology, the prospects for achieving transformative impact in the WASH sector and beyond are truly exciting.
