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    • Focus On: Innovation

    DevExplains: Behavior-centered design for development

    Knowledge isn’t always enough to change behavior, according to scientists at the London School of Hygiene and Tropical Medicine. Devex caught up with the experts on the invisible forces behind behavior and understanding the settings to better reach key populations.

    By Jenny Lei Ravelo // 13 December 2016
    Development organizations aiming to influence people’s everyday actions often rely on messaging to recommend safer and healthier habits. But when these attempts don’t provide the desired outcome, it’s likely that the problem lies in the approach. That’s because knowledge isn’t always enough to change behavior, according to Valerie Curtis, a behavioral scientist and director of the Environmental Health Group at the London School of Hygiene and Tropical Medicine, and Robert Aunger, associate professor on evolutionary public health at LSHTM. The two have studied the nature of behavior for years and learned that “invisible forces” such as people’s motivations and habits, as well as their environmental settings, also contribute to how they behave. By understanding this concept, organizations aiming to change people’s behavior to improve their health would have better chances of achieving their goals. “We need to understand settings better because they control us,” Curtis said during a TEDx Talk in November 2015. “And if we understand them, we can control them.” How? Curtis said disrupting settings, such as social norms in a community, could lead people to change their behavior. So Curtis and Aunger, armed with this theory of change, developed an approach they call behavior-centered design, which they’ve employed in several health-related projects for the past five years. This approach involves a systematic process on how individuals or organizations can forcefully disrupt settings to elicit a change in behavior in their target population, from children washing hands after using the toilet to mothers observing safe food practices for their baby’s well-being. Devex dug in to find how it might apply to your work. What does the process look like? The behavior-centered design process contains five steps: 1. Assess the problem through literature review and discussions with different stakeholders. 2. Build further understanding of what influences people’s behavior through field-based data collection. 3. Create the intervention, usually with the help of creatives such as ad agencies. 4. Deliver the intervention to the target population. 5. Evaluate what degree the intervention helped changed behaviors. OK. But how does it work in practice? Aunger gave the example of a project the BCD team conducted in 14 villages in Andhra Pradesh, India, from May 2011 to September 2012 to create a picture of how this works in practice. The team reviewed available research on handwashing behaviors in several countries, where they learned key lessons — for example, that disgust over dirty hands and people’s limited resources influence behavior in washing or not washing their hands with soap. Afterward, they went out to the field to build their understanding of what influences people’s behavior on handwashing. For example, they looked at people’s concept of cleanliness, or if community members are adhering to any cultural and religious beliefs preventing them from washing their hands with soap. Given the information they collected, the team then engaged a Bangalore-based agency to help them create and design the most appropriate intervention to appeal to mothers’ emotions. In this case, it came in the form of videos, skits and public pledging ceremonies where women promised to wash their hands with soap. The team monitored changes in people’s attitudes six weeks after the intervention by observing people’s handwashing behavior during particular times of the day when they are most likely to go to the toilet or eat. This was followed by another monitoring six months and 12 months after the campaign. Observed rates of handwashing with soap in the target population increased to 19 percent after six weeks and to 37 percent six months after the campaign, according to a study of the campaign published in February 2014 on The Lancet. How can organizations interested in this approach apply this design in their behavior change programs? The above example gives organizations an idea of how the BCD approach works, although it should be noted that the process entails more rigorous work. Curtis and Aunger have come out with a guide on the BCD process, but it can prove to be challenging without guidance from behavioral science specialists. The good news is that Curtis and Aunger will be coming out with a training kit specifically targeted for NGOs in the next three months. The kit will give NGOs a bit of the theory behind the approach, as well as help them go through the five-step process, according to Aunger. “It should be a good resource for people who have a lot of interest, but not a lot of background [on the way behavior change works],” he said. Are videos necessary for this kind of approach? The team has made use of videos on a number of interventions, from promoting handwashing in a village in Andhra Pradesh, India, to encouraging breastfeeding among mothers in a region in East Java, Indonesia. These videos were shown to households using tablets during door-to-door campaigns or in a screen during community events. But organizations need not necessarily use videos in their interventions, Aunger said. “It helps if you have a very powerful core element to your campaign,” he said. “In our case it’s often been an ad, but it could just be a poster or slogan or an image or an inspirational figure.” Is it only applicable for public health interventions? No. It’s designed to be generally applicable to different kinds of behaviors, Aunger said. But most of the available literature and interventions where the design has been used so far are linked to health. Is there anything development organizations need to keep in mind when trying this approach? People’s exposure to the campaign can be a powerful element of the approach, Aunger suggested. In a project in Zambia, the team was tasked with brainstorming an idea to reduce diarrheal disease by targeting multiple behaviors, such as handwashing and promoting the use of oral rehydration salts. They decided to create a video that would make these behaviors look more a part of the social norm. However, they weren’t as successful in changing behaviors in the community, said Aunger, who gave two possible reasons for this: One is that they were trying to change multiple behaviors at the same time. The other reason was that the videos were perhaps not reaching a wide enough audience.

    Development organizations aiming to influence people’s everyday actions often rely on messaging to recommend safer and healthier habits. But when these attempts don’t provide the desired outcome, it’s likely that the problem lies in the approach.

    That’s because knowledge isn’t always enough to change behavior, according to Valerie Curtis, a behavioral scientist and director of the Environmental Health Group at the London School of Hygiene and Tropical Medicine, and Robert Aunger, associate professor on evolutionary public health at LSHTM. The two have studied the nature of behavior for years and learned that “invisible forces” such as people’s motivations and habits, as well as their environmental settings, also contribute to how they behave. By understanding this concept, organizations aiming to change people’s behavior to improve their health would have better chances of achieving their goals.

    “We need to understand settings better because they control us,” Curtis said during a TEDx Talk in November 2015. “And if we understand them, we can control them.”

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      About the author

      • Jenny Lei Ravelo

        Jenny Lei Ravelo@JennyLeiRavelo

        Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.

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