Amongst the most critical steps in the behaviour change intervention design process are (1) choosing a behaviour change tactic that has evidence of changing the behavioural determinant that you identified and (2) that you use that behaviour change tactic bearing in mind the implementation parameters for that tactic, that is, understanding the conditions under which the behaviour change tactic will be effective (Kok et al., 2016).
In this article, I share five examples of the operationalisation or practical implementation of some behaviour change tactics (aka ‘methods of behaviour change’, ‘behaviour change techniques’ or ‘behaviour change principles’) in development projects.
Behavioural journalism is an effective technique in changing social norms about topics that may be regarded as taboo. It uses mass media to share stories of behaviour change based on authentic interviews with the target group.
A great example of this is the youth sexual and reproductive health project Merci Mon Héros. The format centres around young people sharing stories of times they faced difficulties related to sex, contraception or relationships. They share stories of how they got help from an older person in the community: a parent, extended family member or community member. Both tell their side of the story and detail how they made the change they needed to make. The videos end with a call to action to use contraception and learn more about sexual and reproductive health. You can read about the preliminary impact of the project here.
Scenario-based risk information
A key factor in people’s decision to take up a preventive or curative heath service is that their risk perception, or the perception that they are at risk of experiencing negative consequences due to inaction, must be high. However, risk perception must be high in conjunction with high self-efficacy and response efficacy. That is, it needs to be clear what people can do to avoid the harmful outcome and hold a belief that the solution presented will indeed be useful in mitigating the harmful outcome.
A good example of how risk perception can be carefully increased is the use of scenario-based risk information. This tactic allows people to create a mental picture of how a future harmful incident can occur by allowing them to create their own mental scenarios. This can be done verbally or in written form, through the description of specific scenarios, or through vignettes. It can also be done using a combination of visual cues and text, as in the example below of a visual aide created to help people gauge the level of risk they are taking in contracting Covid-19 when they engage in specific activities.
A tactic that can work well in changing behaviour at the individual or group level by increasing motivation is normative feedback. It works by presenting information about what others who are similar to the target audience are doing. In this sense, it also works by influencing perceptions about descriptive norms (what others like us do).
Below is an example of how MSI Reproductive Choices, tested normative feedback in their clinics in Nepal. Depending on the current clinic status, the posters would suggest ways to improve or commend high-performing centres. The aim was to increase nurse’s counselling and offering of post-abortion family planning (PAFP) and inform women of the choice to get a long-acting reversible contraceptive (LARC) such as an intra-uterine device or implant. Every month, clinics got feedback on how they performed in comparison with three other similar clinics. Green indicated good performance and red indicated poor performance. You can read about the impact of the intervention here.
Attitudes have strong underlying belief components influenced by perceptions of the self as well as the community that one lives in. Programmes that want to change attitudes towards products or services must address attitudes at the individual level as well as a person’s experiences externally.
An effective approach to changing attitudes is self-revaluation. It works by allowing individuals to reflect rationally and emotionally on their self-image and their lives with or without the service or product being promoted. Since it often leads to awareness-raising as well, it is important that the process is guided by a person that can offer direct access to the service or product.
Another great example comes from MSI Reproductive Choices in Pakistan. The Improving Reproductive Health Through Awareness, Decision and Action (IRADA) project was built around three steps, the first of which used self-revaluation. It included facilitated “photo discussions to promote self-reflection on critical life-choices, using a timeline to help women understand their life-course and daily routines; drawing body maps to understand their own bodies and role of contraception; and social maps to identify environmental barriers to women’s mobility.” Full details are available here.
Developing new social network linkages
Social networks are often critical to the uptake of services and products. When the usual tactics are not working or when a new product or service needs to be introduced, creating new social networks is often crucial.
A fantastic example of how this can be done is a tuberculosis (TB) case detection project in Nigeria. It developed new networks to increase TB testing through:
- Chemists or medicine-dispensing stores, which gave TB testing referral cards to clients who they suspected of having TB.
- Religious leaders who disseminated messages on how to spot TB symptoms to get tested.
- Community members, using social support messaging, to recognise symptoms and get tested.
You can watch the full video here.
Do you have examples of behaviour change tactics? Share them with me here!
Kok, G., Gottlieb, N. H., Peters, G. J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A. C., Fernández, M. E., Markham, C., & Bartholomew, L. K. (2016). A taxonomy of behaviour change methods: an Intervention Mapping approach. Health Psychology Review, 10(3), 297–312. https://doi.org/10.1080/17437199.2015.1077155