Behaviour Centred Design
What is Behaviour Centred Design?
Behaviour-Centred Design is a radically new approach to behaviour change for public health. Developed by a team at the Environmental Health Group of LSHTM, it builds on evolutionary and environmental psychology as well as best marketing practice to design and test imaginative and provocative behaviour change interventions. We have shown that the approach works to change handwashing behaviour in rural India (SuperAmma), to change food hygiene behaviours in rural Nepal, to change infant feeding behaviours in urban Indonesia and to prevent diarrhoea in Zambia. Other BC projects are in development.
Resources on the approach include:
- A peer-reviewed introduction to the approach
- A practitioners guide to the approach: Guide to Behaviour Centred Design.
- BCD Formative Research Protocols for those interested in going beyond focus groups and interviews.
Below you’ll find a webinar explaining the Behaviour Centred Design approach, with examples and some applications to HIV.
The approach has five steps:
A: Assess what is known and not known about the behaviour in question and define the parameters of the intervention, including specifying the exact behaviours to be changed. We organise this in a framing workshop.
B: Build-carry out Formative Research-often using innovative techniques including videoing and motive mapping. The results provide us with the insights that go into the creative brief.
C: Create the intervention with the help of professionals from local or international creative agencies
D: Deliver the intervention, through appropriate channels (including mass media, village and school events, local extension agents, activation agencies). The emphasis is always on exciting and motivating activities focused on changing behaviour, and never on preaching about health.
E: Evaluate the intervention, using the best means available, (usually a controlled trial), complemented by a process evaluation to learn what worked and what didn’t for next time. We use a variety of means for measuring behaviour including direct observation and electronic sensors, when feasible.
The theory which underpins BCD we call Evo-Eco, for its foundations in evolutionary biology and ecological psychology. It is based on understanding that the human brain evolved for the purposes of guiding behaviour that would have been adaptive, enhancing inclusive fitness in the environments in which we evolved. Some behaviour is under rational calculated control but much is determined by our 14 motives, and the control of everyday behaviour is often passed to automated habitual processes that fit our daily routines. Motives, such as disgust, nurture and affiliation are areas of research for our group, as well as the processes of habit formation. Settings are another key theoretical concept that we employ to change behaviour. All behaviour takes place in social, physical settings in a particular temporal sequence. Changing settings such as a kitchen layout, a social role or a routine is often key to changing behaviour.
Our current projects which utilise Behavior Centred Design
With funding from the Wellcome Trust, we designed a cluster randomized control trial of handwashing with soap in a rural Indian population. This involved assessing the current state of handwashing practice, building that knowledge via formative research, creating a 12-minute animated film and village activation plan with Centre of Gravity, delivering the intervention through two local promoters with the help of Mudra Max, while St John’s Research Institute supervised delivery and conducted the evaluation of the campaign. This project was successful in increasing handwashing rates from a state of near absence to sustained practice in nearly one-third of the target population.
The findings of the intervention trial were published in the Lancet Global health Journal and can be found here. More recently a follow up article was publish, detailing the lessons learnt from the process evaluation of the intervention. This was published in BMC Public Health and found that the intervention was locally acceptable, effective in its reach and potentially scaleable. This recent article can be found here.
The SuperAmma campaign is currently being adapted, under the aegis of the Water Supply and Sanitation Collaborative Council (WSSCC), for use in a combined sanitation/handwashing intervention in Nigeria.
We serve as technical collaborators on Project Baduta, operating under the auspices of the Global Alliance for Improved Nutrition (GAIN), under the supervision of the Ministry of Health, and with participation of Save the Children and Indofood. The project aims to sustainably improve the health and nutrition of children of low income Indonesian families in Sidoarjo Regency aged 6 to 24 months (‘baduta’) by increasing the usage of affordable nutritious complementary foods and reducing use of industrial milks (and hence supporting mothers to continue breastfeeding). To assess the current state of the art, we held a Framing Workshop in Sidoarjo with global and local experts in nutrition, behaviour change, and creativity. Building on this knowledge, we conducted formative research to investigate current baduta feeding practices, and identified factors constraining or facilitating more healthy practices. We then used insights identified through this research to create a feasible and scalable behaviour change intervention to promote the target behaviours, together with Playgroup, a local creative agency. The basic idea is to manipulate social norms via gossiping. We are currently delivering this campaign via mass media spots and community activation efforts. We will soon evaluate the effectiveness of this campaign and hope to scale it up, with the help of GAIN, to national level.
This project will likely extend to maternal nutrition in the near future.
The television adverts used during this campaign can be viewed below.
A description of the ‘Emo-demos’ used in this intervention is available here: Emo-Demo Descriptions.
Read the impact paper related to this study here.
Program for the awareness and elimination of diarrhoea (PAED)
Together with the Centre for Infectious Disease Research in Zambia (CIDRZ), and with funding from Absolute Return for Kids (ARK), working together with the Zambian Ministry of Community Development, Mother and Child Health and the Ministry of Health, we aim to promote a number of behaviours associated with diarrhoea reduction in children: exclusive breastfeeding, handwashing with soap, use of oral rehydration therapy (ORS) and the timely giving of zinc tablets. The BCD approach was used to frame an assessment of how these multiple behaviours could be linked in a single campaign. We built on these ideas by conducting formative research in Lusaka Province, using the wide variety of formative research tools we have developed to provide significant new insights into target behaviours, emphasizing the ability to capture (e.g., via video) and analyse actual target behaviour. This fieldwork generated insights that fed into the creation of an appropriate and effective behaviour change intervention to reduce morbidity and mortality associated with diarrhoea among children under five. This intervention, based on the idea of a group of gossiping women who watch the behaviour of others, will be delivered soon through radio and TV ads, as well as at-home events and community roadshows, and will be evaluated by LSHTM, in collaboration with others.
Read about the formative research for this project in the Zambia Formative Research Report.
Watch the campaign videos below. Make sure you can see the subtitles – just go to the settings wheel at the bottom of the video screen, then click subtitles and select English.