introducing foam: focus, opportunity, ability, motivation a draft behavior change model for hw...
TRANSCRIPT
Introducing FOAM:Focus, Opportunity, Ability, Motivation
A draft behavior change model for
HW programs
Dakar, May 29, 2007
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Overview of Presentation
Background
Behavior change models
The Hanoi Workshop
Next steps
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Background
Many tools available (eg. Handwashing Handbook)
All stress audience-centered programming
Lack of holistic model to explain all factors influencing HW
Global Scaling Up HW Project presents an opportunity Learning objective Common framework
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What is a BC Model
Diagram that represents the various “determinants” of behavior change “Determinants” are internal or external factors that
influence an individual to perform a behavior
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Advantages of a BC Model
Provides a common language Identifies critical linkages Informs M&E Enables evidence-based and comprehensive
programming Can be adapted across populations
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Foundations of BC Models
Draw on disciplines such as public health, marketing, communication, advertising, business, social psychology and consumer behavior
Foundations include Health Belief Model, Theory of Reasoned Action and The Stages of Change which have been studied extensively
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Two Examples of BC Models
WB’s BC continuum PSI’s PERForM
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World Bank BC Continuum
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PSI’s PERFORM
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USE RISK -REDUCING BEHAVIOR
HEALTH STATUS QUALITY OF LIFE
OPPORTUNITY ABILITY MOTIVATION
POPULATION CHARACTERISTICS
SOCIAL MARKETING INTERVENTION
PRODUCT PLACE PRICE PROMOTION
AT RISK
Attitudes Belief
Subjective Norm
KnowledgeAvailability Brand Appeal
Quality of Care
Threat
Outcome Expectation
Intention Locus of Control
Willingness to Pay
Self Efficacy
Social Support
Social Norm
Brand Attributes
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Examples of PERForM Applications in Cambodia
Data: 2003 sero-surveillance: 42% new HIV/AIDS cases from
husband to wife Formative research: low condom use with trusted
partner due to 1) low perceived risk and 2) low social support – confirmed later through TRaC survey
Number One: widely available (over 95% of brothels) and affordable but associated with commercial sex
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Examples of PERForM Applications in Cambodia (2)
Program responses: launch of OK Condom “Klahan” (Be brave) BCC campaign
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OK Condom
Marketing strategy: Different product launched with family planning positioning in
2004 Differentiated distribution channels from Number One condom Advertising and promotion includes mass media and
sponsorships
Key results: Total condom sales in Cambodia grew from 20 million in 2004
to over 25 million in 2006 OK Condom’s share at 10% of total sales
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Klahan BCC Campaign
Aimed at building social support and improving personal risk perception among trusting couples
Integrates mass media (8 TV and radio spots), mobile video units, website and outreach through NGO peer-educator networks
Key determinants and exposure tracked through TRaC annual surveys
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Spots
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Generic Vs Branded
Generic (BCC) campaigns aim to change knowledge, attitudes and beliefs related to intended behavior and/or build “primary” demand for product category
Branded build “secondary” demand for product
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Generic Vs Branded (2)
PSI generally does not put product brand on “generic” or BCC campaigns: Enhances credibility Facilitates stakeholder buy-in Facilitates use by partners
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PERForM and M&E
TRaC = annual targeted KAP-type surveys Compares those who perform the desired
behavior to those who do not Identifies key determinants correlated to desired
behavior Establishes dashboards, allows for monitoring
and campaign impact evaluation
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The Hanoi Workshop
Held April 24-27, 2007 Participants included HW Coordinators,
GoV/MoH and Global team Facilitated by a communication consultant Key objective: develop a global behavior change
model for the “Scaling up HW Behavior Change” project
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Process
1. Agreement on expectations and parameters
2. Review of existing frameworks
3. Overview of research and theories on change
4. Country/regional presentations
5. Identification of relevant determinants for HW
6. Decision to group determinants under opportunity, ability and motivation
7. Development of draft BC model FOAM
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F in FOAM
Focus: desired behavior (consistent
HW at critical times)target populations
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O A M
Opportunity: institutional or structural factors that influence an individual’s chance to perform a behavior
Ability: individual’s skills and proficiency to perform a behavior
Motivation: drives, wishes, urges, or desires that influence an individual to perform a behavior
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Access/availability
Product attributes
Social norms
Knowledge
Social Support
Attitudes & beliefs
Intention
Expectations
Threat
Focus Opportunity Ability Motivation
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Opportunity
Availability/access: ease of obtaining the cluster of goods and services needed for the behavior
Can I get water/soap when I need it?How far to go to get it?Is there water and soap when I wash hands? What is the price?Can I buy it when I need it?Am I able to make the decision to buy soap?Who makes the decision to buy soap?
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Opportunity (2)
Product attributes: perceived or actual characteristics of goods and services
Does soap smell good?Does water look clean?Is the color (soap or water) nice?Is it anti-bacterial? Is the soap agent I have at home
appropriate for all critical times?
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Opportunity (3)
Social norms: behavioral standards which exist in the community for an individual to follow
Are people around me washing their hands with soap?
Who around me is washing hands?
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Ability
Knowledge: true facts accumulated through learning about objects, actions, and eventsDo I know why HW is important? Do I know that washing with water is not good
enough?Do I know when to do it? Do I know that germs that are invisible can make
me or my child sick?Do I know that HW can prevent my child from
getting diarrheal disease and ARIs?
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Ability (2)
Social support: Physical, emotional, or informational assistance an individual or community gives or receives for a behavior
Has anyone talked to me about HW?Has anyone helped me to HW?Has anyone made me feel good about
HW or rewarded me?
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Motivation
Attitudes and beliefs: perceptions or mental positions about a product or behavior. Evaluations or assessment of a product or behavior which may or may not be true.
Do I believe that HW is necessary? Do I believe that HW improve my child’s health?Do I think that all soaps the same and equally
effective?
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Motivation (2)
Expectations: what an individual thinks will happen as a result of performing the behavior.
Will washing my hands reduce my child’s immunity?What will others think of me if I HW? How much do I
care what they think (subjective norms)?What do I think could happen if I HW? What if I do
not HW? Does God/fate decide whether my child will suffer
from diarrhea or ARI (locus of control)?
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Motivation (3)
Threat: perceived danger or harm associated with performing or not performing the behavior
How likely is my child to get diarrhea or ARI (susceptibility)?
How dangerous is diarrhea or ARI for my child (severity)?
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Motivation (4)
Intention: individual’s plan to perform or facilitate the behavior
Am I planning to install a HW station?Next time I go to the toilet/feed my baby
am I going to washing your hands with soap?
How much am I willing pay?
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From Model to Practice
FOAM can be integrated into existing tools and frameworks
Enables full marketing mix vision Informs monitoring/MIS Informs the formulation of communication
objectives in the advertising brief FOAM Operational Matrix (FOM) can be used for
planning purposes
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Enabling Environment
Population Characteristics and HWWS Behavior
Research
Focus
Opportunity Ability Motivation
Key determinants
Marketing mix
Program Objectives
Product
Monitoring and evaluation
Price Place Promotion
Implementation
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Concept & Message development
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Channel Choice
Advocacy development
Communication Strategy
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FOAM Operational Matrix (FOM) from VN
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Next Steps
Feedback from PPPHW BCC sub-working group and SC Country-level validation/training workshops
Vietnam workshop tentatively planned early July Tanzania FOAM workshop planned for mid July
Identification of key determinants to be tracked in household surveys based on formative research
Inclusion of FOAM communication objectives in advertising agency briefs and spot formative research
Training or TA on application of FOAM for HWTM