Using FOAM to scale up HWWS - a framework to operationalise behavioural determinants for planning, implementation and results Yolande Coombes
Why Handwashing ? 70 Diarrhea is one of the major Reduction in diarrhea morbidity (%) Previous reviews Fewtrell et al. (2004) 60 killer of children under 5 50 40 30 20 Source: Cairncross “The Health Impact of Sanitation” presentation to the Gain one year of life free of disease and disability Rural Water and Sanitation Thematic Group in August 2004. a – d Esrey SA 1 0 et al. (1991) Bull WHO 69 (5): 609-621; e Curtis V, Cairncross S (2003) Lancet Inf Dis 3: 275-281. 0 (a) Sanitation (b) Water (c) Water (d) Hygiene (e) Hand availability quality promotion washing for $3 if you promote HWWS One of the most cost- effective intervention Cost Effective Ratios Mean US$/DALY for $2750 if you promote cholera immunization for improving child Hygiene promotion (i.e. HWWS) 3 survival Sanitation Promotion 11 Water supply through house connection 47 Water supply through hand pump or standpost 94 Source for cost-effective ratios: Second Edition of Breastfeeding promotion 850 Disease Control Priorities in Developing Countries, World Bank (2006) 2 Cholera or Rotavirus immunization 2750 0 500 1000 1500 2000 2500 3000
Cost Effectiveness of Hygiene and Sanitation compared to other public health interventions 3
Global HWWS project Share Evidence and Learning Build capacity of governments and partners Develop and Strengthen HWWS behavior change programs. SCALE and SUSTAIN: 5.4 Million Women and Children Peru, Senegal, Tanzania Vietnam Performance Monitoring/ Learning Impact Evaluation Behavior Change Enabling Interventions Environment
Background Deliverables Preparation Implementation Strengthening the EE Enabling Institutional Environment Performance Monitoring Assessment Action Plan Communications Mass Media Campaigns Integration of Promotional events promotion into existing services Behavior change Capacity Building strategy* Community and Incentives mobilization/ Formative interpersonal Research* Convenient access Demand-driven to water & soap HW stations *Guided by FOAM framework
Why do we need a framework? 1. To help us decide where the need is greatest 2. To help us understand why people behave or don’t behave 3. To help us plan how to support them to behave 4. To help us identify what we do and don’t know about and what we need to know more about.
The AOM framework and its causal relationship Opportunity Motivation Behavior Ability
Using FOAM As Framework Focus Opportunity Ability Motivation Beliefs & attitudes Access/availability Target behavior Knowledge Outcome expectations Product attributes Threat Target population Social support Social norms Intention
Vietnam Focus Target behavior Target population 9
• Peru Opportunity Access/availability Product attributes Social norms 10
Senegal Ability Knowledge Social support
How can we priortise FOAM to take forward for communication development ? High Potential Activities Strong to be addressed Communicable other than through habit changers – do Communication now ! Ability to change peoples behavior Consider for STOP DOING tactical opportunities Low High Ability to influence with Communication
How can we priortise FOAM to take forward for communication development ? Social High Norms Social Support Attitudes and beliefs Ability to change peoples behavior Access / Expectations Intentions Availability Knowledge incl existing resource usage Product Attributes Threat Low High Ability to influence with Communication Opportunity Ability Motivation
Advertising Public Relations Partnerships Experiential Response Consumer Promotions Purpose Salience Credibility Association Engagement Relationship Conversion Roles Persuasion via Influence via Relevance via Engagement via Relationship via Conversion via salience credibility association experience recognition incentive Channel Image Trust Values Interaction Trial Trial Use Immediacy Rapid Response Content Immersion Loyalty Urgency Reassurance News Endorsement Depth Personifications Proximity Stature Endorsement Prestige Participation Reward Reward Awaken Radio and print on News coverage of Promoting buy-in; DCC and IPC on key Phase key junctures for campaign in training local, junctures and HWWS, and newspapers national importance of soap, importance of government on constructing tippy taps soap; Wall HWWS and washing hands branding Inspire Radio phone-in Soap packaging Radio phone-in with Promotional DCC and IPC – Phase with HWWS with messages HWWS experts items constructing tippy experts taps and winning promotional items Empower Radio Soap opera IPC and DCC Tippy Taps comic DCC events for Phase promoting mother as Radio Soap mothers as heroes heroes; Tippy Taps opera ready for comic competition Amplify Radio Sponsorship News coverage of Radio spots of Engagement through Asante Mama Asante Mama Phase for Asante Mama Asante Mama Famous people media, DCC and IPC on through media, through media, DCC saying why their Asante Mama – DCC and IPC and IPC mothers are nominating mothers heroes; as heroes HWWS ambassador Sustain Radio spots and Soap packaging IPC Phase soap opera
Opportunity Ability Motivation Tanzania Beliefs & attitudes Access/availability Knowledge Outcome expectations Product attributes Threat Social support Social norms Intention 15
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