Understanding Behavior Change for Safe Water

Transcription

1 Understanding Behavior Change for Safe Water Maria Elena Figueroa Photo by Risang Rimbatmaja National Conference for Household Water Treatment and Safe Storage Jakarta, Indonesia. August 20-21, 2008

2 Why should we care about Poor water quality continues to be a major health threat. Diarrhea alone kills worldwide, about people, every day, most of them young children. Most of this problem, the result of unsafe water, poor sanitation and hygiene. behavior for safe water?

3 Improved water sources and safe water 1.1 billion people lack access to improved water sources Recontamination due to transportation and storage Treatment at the household level, about 2x as effective as treatment at the source WHO, 2007; Clasen, 2005

4 Improved water sources and safe water 1.1 billion people lack access to improved water sources Recontamination due to transportation and storage Treatment at the household level, about 2x as effective as treatment at the source WHO, 2007; Clasen, 2005

5 Improved water sources and safe water 1.1 billion people lack access to improved water sources Recontamination due to transportation and storage Treatment at the household level, about 2x as effective as treatment at the source WHO, 2007; Clasen, 2005 Behaviors to address

6 POU water treatment technologies Boiling Filters Chlorination Chlorination and flocculation Solar disinfection, Others (UV light)

7 Water treatment and safe storage are not sustained practices among people that need them most

8 Why is behavior so difficult to change? Our assumptions are wrong Many behaviors have powerful advocates Some can, others can t Our behavior change interventions are based on our theories of behavior change

9 What have been our assumptions and theories? Most public health interventions worldwide: Emphasis on health benefits, - disease, severity action-behavior Emphasis on attributes of the technology or the service rather than consumer needs - Knowledge approval practice-use These approaches have had limited effect

10 Model of Communication and Behavior C O M M U N I C A T I O N INSTRUCTION DIRECTIVE Dissemination Promotion Prescription NONDIRECTIVE Dialogue Counseling Entertainment Social Networks PUBLIC Services Advocacy SKILLS & KNOWLEDGE PSYCHO-SOCIAL FACTORS COGNITIVE Beliefs Attitudes Values Perceived Risk Subjective Norms Self-Image EMOTIONAL Emotional Response Empathy Self-Efficacy SOCIAL Bounded Norm. Influence Personal Advocacy ENVIRONMENT Access to Water Sources, Water and Sanitation Technologies & Community Organizations confirmation reinforcement enabling INTENTION BEHAVIOR Water Treatment and Safe Storage Household Sanitation Hand Washing Community Sanitation

11 Two key implications from this model

12 Two key implications from this model 1 st : Behavior change programs need to address psychosocial factors if they want to succeed

13 A predictive model of communication & change: Influence of ideational elements on behavior Personal Advocacy Knowledge Attitudes Implies simultaneous effect of all influences. Social Support & Influence BEHAVIOR Self- Image Emotions Self- Efficacy Norms Perceived Risk Implies communication can affect all influences.

14 Examples from Guatemala and Pakistan

15 Water treatment behavior, Guatemala 2003 Percentage Not treating Boiling Chlorine Filter PUR Other* Treatment Method Sample size = 1,500 * Includes filter w/cloth/strainer, solar disinfection and others.

16 Psychosocial factors identified for water treatment in Guatemala,, Have positive attitudes toward water treatment 2. Like the taste of treated (boiled) water 3. Have self-confidence in the water they prepare 4. Have talked to their partner about treating water 5. Perceive the majority treats their water Factors are context-specific

17 Percent of water treatment by the number of ideational factors which apply 100 Percent Guatemala None Overall Cumulative Number of Factors that Apply Chi2 (5 df) = p<.001; N = 1,500

18 Water treatment behavior, Pakistan 2005 Percent None Boiling Cloth Filter Method Used PuR Alum Others N = 1500

19 Psychosocial factors identified for water treatment in Pakistan. Sindh, Attitudes toward water treatment 2. Knowledge of water treatment methods 3. Social influence: Talked to husband, husband supports, talked to others, others have recommended, has advocated to others 4. Perceived norms Relatives or friends treating water at home

20 Percent treating water by number of ideational factors. Sindh, Pakistan 2005 Percent Overall Cumulative Number of Factors that Apply Factors explored: Knowledge of treatment methods, attitudes toward water treatment, social influence (talk to others), perceived norms. Adjusted for sociodemographic, water source & perceived quality & other confounders.

21 Water treatment behavior, Indonesia 2005 Percent None Boiling Kaporite Filter Others Method Used Basic Health Services Survey 2006

22 Attitude statements identified for new product in Indonesia Measured in Binjai 2006, Sulawesi 2007 and Tangerang No need to boil if there is a product that could turn unboiled water into drinking water 2. There are other ways as good as boiling to make unbolied water safe to drink 3. Kaporite is as good as boiling water to kill germs 4. Kaporite is safe to turn unboiled water into drinking water at home 5. It is OK to drink unboiled water if there is a solution one can add to kill germs in water

23 Attitudes toward new product. Binjai,, North Sumatra 2006 Density Disagreement 49.6% Disagreement Uncertainty 44% Agreement Agreement 6.0% mean(unstandardized items)

24 Attitudes toward new product. Tangerang, Banten 2008 Density Disagreement Disagreement 19% Agreement Agreement 31.5% mean(unstandardized items)

25 Attitudes toward new product Binjai, 2006 Density Tangerang, mean(unstandardized items) Density mean(unstandardized items) Shift in part due to regional differences but also to the communication about the new product

26 Determinants of the Rate of Adoption of New Technology (Innovation) 1. Attributes of the Innovation Relative advantage Compatibility Complexity Trialability (Divisibility) Observability (Comm.) 2. Locus of Decision (Adopter) RATE OF ADOPTION OVER TIME 3. Nature of Social System 4. Communication Channels 5. Change Agent Promotion Source: Rogers (1995; 1962)

27 Attributes of the technology Relative advantage Is the innovation better than the status quo? Will people perceive it as better? Compatibility Will people perceive it as consistent with existing values, previous experiences, and needs?..with this product I don t worry about accidents with kids boiling water. Our water is quite safe and clean enough for us. Adapted containers to fit local preferences & needs

28 Attributes of the technology Complexity How difficult is the innovation to understand and apply? Is it too complicated? Trialability Can people try the innovation or should they commit to it all at once? PuR needs 2 buckets of 10+ liter each, scissors, a large spoon, and a cloth. In some places, people lack utensils. Rp.500

29 Attributes of the technology Observability How visible to others, are the results of using the technology? SODIS, highly visible Need word of mouth promotion and outdoor visibility

30 Two key implications from this model 2 nd : Communication for behavior change needs strategic, integrated multimedia approaches

31 Not isolated posters and messages PPT CCP 8/19/

32 Strategic communication is participatory PPT CCP 8/19/

33 uses Entertainment Education to engage the public Bangladesh/Shabuj Shathi

34 ..engages local organizations and champions Local radio in Kenya Schools in Indonesia 615 PPT CCP 6/7/00 34 Soccer team, HIV prevention Africa

35 ..get leaders support Minister of Social Welfare demonstrating AR Minister of Health during AR launch

36 Role of leaders communication networks

37 Social network of women in Bojong Renged, by use of Air RahMat Black = Never Users Red = Ever used Blue = Current Users

38 Sustained behavior more likely to happen when there are 4 elements in place:

39 Four elements for sustained behavior: Supportive environment: policy decisionmakers engaged, provide resources, media involved... Jordan/Religious Leaders

40 Four elements for sustained behavior: Efficient delivery systems: services and products available, health and other services promote the behavior,.. Air RahMat water treatment product Indonesia Blue Circle for Private Sector Services

41 Four elements for sustained behavior: Nurturing communities: where the behavior is the norm, support groups, ownership,.. Communication Creates Community Norms

42 Four elements for sustained behavior: Individuals and households have the motivation, knowledge, skills, attitudes, and resources to practice the behavior Hand washing with soap in Aceh, Indonesia Young man using AR in Bantaeng Photo by Abigael Ati

43 Terima Kasih! Photo by Ika Francisca/SWS