Updated: Wednesday 11 January 2006

Behavior Change

Influencing Hygiene Behavior

HIP’s mandate is to apply behavior change approaches to improve hygiene practices at scale. Improved hygiene practices protect individuals from contact with pathogens in the environment. The specific hygiene practices HIP will focus on include: hand washing with soap, safe disposal of feces, and safe treatment and storage of water at the point of use.

HIP will draw on the existing evidence base in hygiene promotion and health behavior change to develop an overall strategy and country-specific approaches. HIP will apply a mixed theoretical base appropriate to each particular context, incorporating traditional psycho-social models of individual behavior change; evolving change models which include the role of policy, culture, and access to products and services; and systems theory and approaches.[1]

The criticisms of most traditional behavior change theories are that they emphasize the individual’s role in deciding to change current practices, and that they pay insufficient attention to socio-cultural and physical environmental influences on behavior. In the last decade, however, ecological and social norm approaches have begun to emerge focusing on increasing participation and enlarging the sphere of influence on practices by considering the effects of systems and environmental on changing individual and community practice.

HIP will use an amalgamation of individual and systems approaches, applying lessons learned in the health, environmental health and water systems sectors. Because hygiene behaviors are influenced by a myriad of individual, interpersonal, cultural, institutional, community and policy factors, HIP’s approach must be expansive enough to address this range of behavioral determinants. Though a stock approach might be desirable, changing and sustaining new practices is highly dependent on context. Understanding this context will be HIP’s first step in developing a behavior change strategy.

To promote improved behaviors, HIP will seek to understand both current and improved practices in their contexts. This will require a careful examination of existing behavior information and may require additional formative research, as needed and appropriate, including multiple consultations with target groups to learn about motivations/supports for improved behaviors as well as practical and perceptual barriers to adopting such behaviors. Complex interactions often occur, and HIP must explore these to develop appropriate behavioral solutions. Motivations for hygiene behaviors, particularly those related to sanitation, do not usually revolve around health issues.

Based on a thorough understanding of the context, HIP will devise a comprehensive, multiple-component behavior change strategy that considers motivations and supports and addresses barriers through actions in many areas – communication, training, policy change, technology, community participation, advocacy – using the basic elements of USAID’s hygiene improvement framework.This highlights the importance of approaching hygiene improvement issues at multiple levels and stressing the interaction and integration of factors within and across levels.

Including systems theory widens the focus of behavior change strategies by encouraging change at scale. A fundamental concept underlying systems theory is the concept of activating interconnected sectors and stakeholders in concert to deliver multiple complementary and reinforcing interventions that reach individuals everywhere they turn in their communities. This concept will reinforce behavior change approaches and strengthen all strategies developed.

[1]National Cancer Institute