socio-psychological determinants for safe drinking water consumption behaviors: a multi-country...
TRANSCRIPT
Socio-psychological determinants for safe
drinking water consumption behaviors:
a multi-country review
Prof. Dr. phil. et dipl. zool. Hans-Joachim MoslerMSc. Jonathan LiljeEnvironmental and Health Psychology Environmental Social [email protected]
Eawag: Swiss Federal Institute of Aquatic Science and Technology
Promotion of Behavior
Behavior
Person
How can we understand behavior?
Need to know these behavioral factors
Promotion of Water Disinfection
Drinking disinfected water
Factor AFactor B
Factor C
Factor D
Person
Behavioral Factors
How can we understand behavior?
Promotion of Water Disinfection
Drinking disinfected water
Factor AFactor B
Factor C
Factor D
Person
Behavioral Factors
Psychology is the Science of Behavior
For knowing the relevant behavioral factors we should use Health Psychology
Only studies which used behavioral psychological theory
The objectives of this review are
1.to show whether by using psycho-social determinants safe water consumption practices can be explained sufficiently well
2.to identify determinants which are with great probability useful to be targeted in all environmental and socio-cultural contexts 3.to recognize determinants which might be specific for different populations 4.to detect determinants which probably are specific for different safe water practices
We identified a total of 15 studies using health psychology in a quantitative way for explaining safe water consumption behavior
Theories encountered: Health Belief Model (HBM) (Rosenstock 1974)Protection Motivation Theory (PMT) (Floyd, Prentice-Dunn & Rogers 2000)Theory of Planned Behavior (TPB) (Fishbein & Ajzen 2010)Health Action Process Approach (HAPA) (Schwarzer 2008)RANAS Model (Risk, Attitudes, Norms, Abilities, Self-Regulation) (Mosler, 2012)
Types of safe water consumption behaviors9 studies household water treatment: 5 solar water disinfection, 2 boiling, 1 household level filter usage, and 1 chlorination. 5 studies on switching to safe sources 1 study looked at domestic well testing to monitor water quality1 study on cleaning behavior of water storage containers
10 Countries: •Benin, Burundi, Chad, Ethiopia (2), Kenya, Zimbabwe •Bangladesh (3), •Bolivia (3), Nicaragua, USA
Template: The RANAS-Model: Risk, Attitudes, Norms, Ability and Self-regulation
Mosler, H.J., (2012). A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research, 22 (5), 431-449.
.
HBM
TPB
PMT HAPA
Authors CountrySafe water option/Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27 Nicaragua SODIS intention and usagen.a. n.a. o + + + o o o o n.a. n.a. n.a. n.a. n.a. n.a.
log .863
Graf et al.29 Kenya SODIS usageo o + + n.a. + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a. n.a.
log .245
Kraemer et al.34 Zimbabwe SODIS intention and usage
n.a. n.a. o + o n.a. o n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a.log .70
0
Tamas et al.39 Bolivia SODIS water consumptiono n.a. o + + o + n.a. + o n.a. n.a. n.a. n.a. n.a. n.a.
.807
Heri & Mosler30Bolivia SODIS usagen.a. n.a. n.a. + + + n.a. n.a. n.a. o n.a. n.a. n.a. n.a. n.a. n.a.
.690
Tamas et al.39 Bolivia consumption of boiled watero n.a. o o + + o n.a. o o n.a. n.a. n.a. n.a. n.a. n.a.
.522
Sonego & Mosler37 Burundi
boiling water for consumption
+ o n.a. + + + + n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
n.a.
Huber et al.39 Ethiopiaconsumption of fluoride free water from household filter
o o o + + o o + n.a. + n.a. n.a. n.a. n.a. o o log .679
Lilje et al.35 Chadchlorination of domestic drinking water
o + o o o + o o o + n.a. n.a. n.a. n.a. n.a. n.a. log .365
switching to safe source
Huber & Mosler31 Ethiopia
consumption of fluoride free water from community filter
o o + + + + o o n.a. o n.a. n.a. o o + +.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
+ o n.a. + + + + n.a. n.a. + n.a. n.a. n.a. o n.a. n.a..688
Mosler et al.10
Bangladesh
consumption of arsenic free deep tubewell water
o o o o + + + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a..590
Inauen et al.33
Bangladesh
use of arsenic free shallow tubewell
+ o o + + + + n.a. n.a. o + + n.a. o n.a. +log .89
4
hygienic handling of water Stocker & Mosler36 Benin
cleaning of water storage container
o + n.a. + o + o + n.a. + + o o o + +.625
water testing Flanagan et al.28 USA
domestic well water testing for arsenic
o o + + o + o o + + n.a. n.a. o n.a. o o.415
Authors CountrySafe water option/Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27 Nicaragua SODIS intention and usagen.a. n.a. o + + + o o o o n.a. n.a. n.a. n.a. n.a. n.a.
log .863
Graf et al.29 Kenya SODIS usageo o + + n.a. + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a. n.a.
log .245
Kraemer et al.34 Zimbabwe SODIS intention and usage
n.a. n.a. o + o n.a. o n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a.log .7
00
Tamas et al.39 Bolivia SODIS water consumptiono n.a. o + + o + n.a. + o n.a. n.a. n.a. n.a. n.a. n.a.
.807
Heri & Mosler30Bolivia SODIS usagen.a. n.a. n.a. + + + n.a. n.a. n.a. o n.a. n.a. n.a. n.a. n.a. n.a.
.690
Tamas et al.39 Bolivia consumption of boiled watero n.a. o o + + o n.a. o o n.a. n.a. n.a. n.a. n.a. n.a.
.522
Sonego & Mosler37 Burundi
boiling water for consumption
+ o n.a. + + + + n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
n.a.
Huber et al.39 Ethiopiaconsumption of fluoride free water from household filter
o o o + + o o + n.a. + n.a. n.a. n.a. n.a. o o log .679
Lilje et al.35 Chadchlorination of domestic drinking water
o + o o o + o o o + n.a. n.a. n.a. n.a. n.a. n.a. log .365
switching to safe source
Huber & Mosler31 Ethiopia
consumption of fluoride free water from community filter
o o + + + + o o n.a. o n.a. n.a. o o + +.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
+ o n.a. + + + + n.a. n.a. + n.a. n.a. n.a. o n.a. n.a..688
Mosler et al.10
Bangladesh
consumption of arsenic free deep tubewell water
o o o o + + + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a..590
Inauen et al.33
Bangladesh
use of arsenic free shallow tubewell
+ o o + + + + n.a. n.a. o + + n.a. o n.a. +log .8
94
hygienic handling of water Stocker & Mosler36 Benin
cleaning of water storage container
o + n.a. + o + o + n.a. + + o o o + +.625
water testing Flanagan et al.28 USA
domestic well water testing for arsenic
o o + + o + o o + + n.a. n.a. o n.a. o o.415
Can psycho-social determinants explain safe water consumption practices?
High quality of prediction of different safe water consumption behaviors: average R2 value of .637
Authors CountrySafe water option/Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27 Nicaragua SODIS intention and usagen.a. n.a. o + + + o o o o n.a. n.a. n.a. n.a. n.a. n.a.
log .863
Graf et al.29 Kenya SODIS usageo o + + n.a. + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a. n.a.
log .245
Kraemer et al.34 Zimbabwe SODIS intention and usage
n.a. n.a. o + o n.a. o n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a.log .70
0
Tamas et al.39 Bolivia SODIS water consumptiono n.a. o + + o + n.a. + o n.a. n.a. n.a. n.a. n.a. n.a.
.807
Heri & Mosler30Bolivia SODIS usagen.a. n.a. n.a. + + + n.a. n.a. n.a. o n.a. n.a. n.a. n.a. n.a. n.a.
.690
Tamas et al.39 Bolivia consumption of boiled watero n.a. o o + + o n.a. o o n.a. n.a. n.a. n.a. n.a. n.a.
.522
Sonego & Mosler37 Burundi
boiling water for consumption
+ o n.a. + + + + n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
n.a.
Huber et al.39 Ethiopiaconsumption of fluoride free water from household filter
o o o + + o o + n.a. + n.a. n.a. n.a. n.a. o o log .679
Lilje et al.35 Chadchlorination of domestic drinking water
o + o o o + o o o + n.a. n.a. n.a. n.a. n.a. n.a. log .365
switching to safe source
Huber & Mosler31 Ethiopia
consumption of fluoride free water from community filter
o o + + + + o o n.a. o n.a. n.a. o o + +.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
+ o n.a. + + + + n.a. n.a. + n.a. n.a. n.a. o n.a. n.a..688
Mosler et al.10
Bangladesh
consumption of arsenic free deep tubewell water
o o o o + + + n.a. n.a. + n.a. n.a. n.a. n.a. n.a. n.a..590
Inauen et al.33
Bangladesh
use of arsenic free shallow tubewell
+ o o + + + + n.a. n.a. o + + n.a. o n.a. +log .89
4
hygienic handling of water Stocker & Mosler36 Benin
cleaning of water storage container
o + n.a. + o + o + n.a. + + o o o + +.625
water testing Flanagan et al.28 USA
domestic well water testing for arsenic
o o + + o + o o + + n.a. n.a. o n.a. o o.415
Determinants which are with great probability useful to be targeted in all contexts
Determinants which may or may not be targeted in all environmental and socio-cultural contexts
% Studies N of studies w/w-o effect
Behavioral factor determining the difference between doers/non-doers
86% 12/14 Perceived others behavior
80% 12/15 Beliefs about costs and benefits
71% 10/14 Feelings about the behavior
54% 7/13 Confidence in performance
50% 3/6 How-to-do knowledge
38% 5/13 Perceived others’ (dis)approval
33% 2/6 Personal importance
27% 3/11 Health knowledge
25% 3/12 Perceived vulnerability
20% 2/10 Perceived severity
Determinants which are with great probability specific for different populations
Differences can be observed between countries and project settings even within one country E.g. SODIS usage was determined by a different combination of factors for each of the six different studies Different combinations of factors explain boiling behaviors in both Burundi and Bolivia. Switching to safe water sources was also explained by varying psychological factors between - Ethiopia and Bangladesh- even within Bangladesh
Behavioral factors are always specific for populations and countries
Determinants which are specific for different safe water practices
Do we find common patterns or systematic differences in the factors identified as relevant for specific target behaviors? No systematic differences in relevant factors from the different types of HWTS options (SODIS vs. boiling vs. filtration vs. chlorination).
No systematic differences between relevant factors for HWTS options compared to switching to safer sources or well testing.
Implications for Practice1. Using psycho-social factors nearly all practices over all studied countries can be explained very well (mean explained variance 64%).
2.Perceived others’ behavior, costs and benefits as well as feelings (e.g. taste) about safe water consumption should nearly always be taken into account in behavior change campaigns.
3. Confidence in performance (self-efficacy), how-to-do knowledge, perceived others’ approval varied more strongly for different target behaviors but also between specific settings and populations and are thus to be evaluated from case to case.
4.The individual’s health risk perceptions played a role in only very few cases.
5. Between countries and between different types of safe water behaviors no systematic differences can be observed.
These findings highlight the usefulness of a systematic approach using psycho-social behavioral determinants in order to design effective behavior change strategies.
For more information about Systematic Behavior Change:
Side event “Systematic behavior change using the RANAS Approach:
an introduction and experiences of implementing organizations”
Convened by Eawag and HELVETAS
Thursday morning 8:30 – 10:00Windflower