What Drives Behavior? Key Factors for Handwashing in Bangladesh

"What behavior will you promote? What key factors will you address to motivate people?"

Designed for practitioners, trainers, and students of behaviour change or social marketing who are asking themselves these questions as they design communication campaigns, this case study from Alive & Thrive (A&T) shares the strategies and resources that emerged from a research initiative carried out in the context of high rates of malnutrition in an effort to improve infant and young child feeding (IYCF) practices. The case study includes several videos/TV spots, a literature review, and various materials from the A&T initiative as carried out in Bangladesh (see Related Summaries, below).

• Videos (available in Bangla and English): Video 1 (see below) shows the steps used to determine the behaviour to be promoted (handwashing to cut down infections as children are introduced to solid foods): 1) Assess existing data, 2) Using trials of improved practices (TIPs), test behaviour against two criteria: (i) impact on child health and growth and (ii) feasibility for families, and 3) Choose the priority behaviour. Video 2 shows how TIPs and household observations led A&T to identify 3 key factors that are "drivers" of handwashing for mothers with young children. Video 3 is a TV spot promoting proper handwashing related to child feeding and encouraging mothers to wash with soap and water before food preparation and child feeding. While the ultimate behaviour is handwashing, the spot's "call to action" is for families to maintain a handwashing station near where the child is fed.
• A 5-page summary [PDF] of the steps A&T took to design the campaign. As detailed here, the initiative began with formative research in December 2010 and January 2011 that involved structured observations of the preparation and feeding of complementary foods, in-depth interviews, focus group discussions (FGDs) with family and community members, and videotaping. The research identified barriers to handwashing such as a misperception about the health risk and a lack of supportive social norms to adopt the practice. Completed in December 2011, TIPs focused on 4 practices. In early 2012, A&T conducted a 3-month intervention study in 20 villages that included: 4 household visits; 3 village meetings along with screening of A&T TV spots; monthly mothers' group meetings; orientation meeting of social influentials including village doctors, imams, and union leaders; handwashing stickers at every household; and mobile phone counseling and a sticker with the counselor's phone number distributed to certain households. Findings from the formative research and intervention study informed the design of an advocacy and communication campaign that included a national workshop, participation in a Global Handwashing Day celebration and a roundtable discussion, TV spots, a poster, a job aid, a reminder sticker, and an advocacy brief. Click here to access the campaign materials.
• TIPs research instruments in Bangla and English: (i) a 12-page quantitative pre-assessment household (HH) survey questionnaire [PDF]; (ii) a 12-page post-assessment HH survey questionnaire [PDF]; (iii) a 26-page presentation reporting on the findings of the TIP study [PDF], which found, in sum, that: 100% of mothers participated fully in the home visits, and 98% HHs installed handwashing stations (HWS); all mothers had tried handwashing with soap, and intention to adopt and continue the practice increased from 29% in the 1st assessment to 75% by the end of the trial; 65% of mothers had tried complementary feeding (CF) by the 1st assessment, and 19% mothers intended to adopt. By the end of the trial, 83% of mothers reported they had tried it and 43% of mothers intended to adopt; by the end of the trial, 15% of mothers intended to adopt and continue the practice regarding 4 varieties of food.
• A series of presentations by A&T staff involved in the initiative as well as International Centre for Diarrhoeal Disease Research (ICDDR,B) personnel working on handwashing and nutrition practices in Bangladesh who were involved in the evaluation process.