“FORMATIVE RESEARCH” FOR SYSTEMATIC BEHAVIOR CHANGE PROGRAM DESIGN
We carried out a formative research for developing a structured hand-washing promotion in three municipalities of Bardiya district of Nepal. The research comprised of baseline survey in randomly selected 600 households along with survey on behavioral factors of RANAS (risks, attitude, norm, ability, and self-efficacy) and qualitative assessment of behavioral determinants of barriers and benefits among the doers and non-doers of hand-washing. The survey, assessment and subsequent intervention design were guided by different aspects we found relevant from the following theories and framework: (i) stages of change; (ii) diffusion of innovation; (iii) user centered design; (iv) social marketing; and (v) behavioral economics. The following have been identified among others to be considered while developing the promotion program in close consultation with the target audience: (a) to work on Attitude and Norm (shown by RANAS survey); (b) emphasize hand washing after cleaning child’s bottom and before feeding a child (shown by baseline survey); (c) promote hand-washing stations (as 92% now wash their hands at the tube wells only); (d) target reducing perceived barriers and increasing perceived benefits (from social marketing), nudging (a concept from behavioral economics) where possible; and (e) work with innovators and early adopters first (from diffusion of innovation). A two pager guide with objectives, overall strategy (including for communication) and activities has also been prepared for piloting and further adjusting the strategy before scaling it in a larger area mobilizing a wider stakeholders (such as municipalities, health-posts and schools) and using mass communications and broader distribution channels.