The world is facing unprecedented humanitarian needs. Today’s humanitarian crisis tend to be greater in number, often in urban settings, longer in duration and broader in regional impact. They generate human sufferings on a greater scale, disrupt essential services, such as water supply or sanitation and put health of large population at risk. Engineers and technical specialists in water, sanitation, energy, environment, and in other related fields play a vital role to respond to these challenges and growing needs. In the humanitarian sector, they are called the public health engineers and today they are increasingly needed! Why public health engineering matters so much in humanitarian crises? And how its related activities are carrying out in such complex environment? This is what this MOOC is all about! The EPFL, EAWAG-SANDEC and ICRC have decided to partner to guide you through this introduction to the fascinating field of public health engineering in humanitarian contexts.
A systematic approach to behavior change
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Из курса от партнера École Polytechnique Fédérale de Lausanne
Introduction to Public Health Engineering in Humanitarian Contexts
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École Polytechnique Fédérale de Lausanne
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Waste management & Hygiene promotion
We focus on a type of solid waste that public health engineers often encounter in humanitarian crises: medical waste. Finally, we discuss the critical issue of behavior change and hygiene promotion in humanitarian crises.
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Christoph LüthiDr.
Sanitation, Water and Solid Waste for Development / Eawag
Javier Cordoba
Water & Habitat Unit / ICRC
Hello to everybody, I'm Hans Mosler.
I'm a professor at the University of Zurich,
working at Eawag in the Department of Environmental Social Sciences.
And I'm the Head of the Environmental and Health Psychology Group.
I will present you the module about hygiene promotion,
using a systematic behavior change approach.
And what this means, I will show you in a few minutes.
But let me share some experiences with you first.
There was an implementation of water supply,
but people still used unsafe wells.
I'm referring to Haiti after the earthquake.
Building of toilets, but nearly no use of very,
very inadequate use, as you see here.
Or we introduced handwashing and there was nearly no or low compliance.
So the question arises, how to introduce behavior change?
We do promotion of behavior and expect behavior change,
but there's a very important statement.
Behavior change starts in the head of the people.
What does it mean?
That something in the mindset of the person has to change.
And what exactly has to change?
We call it factors, behavioral factors or
psychosocial factors like knowledge, perceived social pressure,
attitudes, beliefs about costs and benefits, and so on.
And very important is also that we make use of the difference
between the doers and the non-doers because these are different.
They have to be different because they show different behaviors.
So here you see that the doers and the non-doers
are different in the fact of C- and in the Factor B-.
So in the first step, we need to identify the behavioral factors.
In the second step then, we want to measure and calculate these factors.
Then we select the behavior change techniques accordingly.
And accordingly means that we select behavior
change techniques which change C or B.
A, we don't have to change.
Then we design and implement the software and at the end, we want to monitor.
We want to evaluate behavior change and the behavioral factors.
Whether we really change C and B, that's here the point.
So we have 4 phases, tools and outputs.
The last phase, I will not introduce here because many times in emergencies,
you don't have the time and the resources.
So I begin with the first step here,
identify potential behavioral and contextual factors.
First, I would like to jump with you in a promotional situation, like this one.
Imagine you are standing behind this desk and
you are promoting chlorination of drinking water.
And before you talk, you have to think what these people think.
So what might it be?
Am I at risk, why?
How to do it?
How should I do it, really?
What does it cost?
What does it bring?
Chlorination costs, of course.
Do I like it?
Do I like it to drink chlorinated water?
What will others say if I chlorinate my water?
Can I do it, or do I need additional devices?
And how to manage it in the daily life.
So these thoughts can easily be arranged into 5 blocks of factors,
risk factors, attitude factors, norm factors, ability factors,
and self-regulation factors, and this is the RANAS Model.
Risk factors are a person's understanding and awareness of the health risk.
Attitude factors are a person's positive or negative stance towards a behavior.
Norm factors represent the perceived social pressure.
And ability factors are about the confidence a person
has in his or her ability to perform a behavior.
And self-regulation factors are a person's attempts to plan and
self-monitor a behavior and to manage conflicting goals and distracting cues.
On the left side, here, you see the behavior change techniques
from which we know that we can change exactly these factors, here.
These factors are the drivers of behavior, on the right side, behavior,
intention and happiness.
Down here, you have the context,
the moderating context which might influence also the behavior.
I now know which behavioral factors I have to test and
I want to measure and determine these behavioral factors.
And we do that with a standardized questionnaire.
We have, for example, here, the norms and the others factor, others' disapproval.
People who are important to you, do they rather approve or
disapprove if you practice open defecation, or if you use a latrine?
From 1, nearly all disapproved, to 5, nearly all approve.
Then we do doer/non-doer analysis.
You see here, the doers are the latrine users and the non-doers,
non-users of latrines.
And you see for person A to W, the score in perceived effort and
the score in others' approval.
Now, we can calculate the mean score for both.
And then look how big is the difference?
And here, for the perceived effort, the difference is not that big,
so we can relieve this factor.
But the difference in others' approval, that's a big difference.
So we have to target exactly this factor.
Okay, we know now the behavioral factors which we have to change.
Now, we select the behavior change techniques.
This, we do with a catalog of 36 behavior change techniques.
This is quite new for you, that there's a catalog of behavior change techniques.
Normally, you have a program like CLTS, or CHC, or FAST, but this is a catalog.
And the advantage here is that for
each of these behavioral factors, you have behavior change
techniques which we know that you can change this factor with.
So for example, others' behavior prompt public commitment,
let people commit to a favorable behavior and make their commitment public, yes?
36 Behavior Change Techniques cover all the RANAS factors.
To conclude here, systematic behavior change enables you, first,
to exactly determine the behavioral factors which you have to change.
This is very, very tailored to your target population.
Then you have a focused election of the corresponding behavior
change strategies, and if you want, you can also prove the record
of success by the evaluation step which I did not present so far.
How to apply it in emergencies?
Well, the key principles are take into account all sorts of behavioral factors.
Not only health risk factors, but also attitude, norms,
abilities, and self-regulation factors.
And perform the doer/non-doer analysis,
ask both kind of people.
And I would also differentiate between the acute phase,
the immediate response, and in established settings like in camps.
For the immediate response, you might do a rapid assessment by
conducting a qualitative analysis with 10 doers and 10 non-doers.
Or without any evidence,
you apply behavior change techniques out of these 5 blocks.
You choose two of each factor block and apply these behavior change
techniques without any evidence, that's also possible.
In established settings, you have time and resources, I think.
Then you conduct a survey with 100 doers and 100 non-doers and
apply step 1 to 3, or even 4 of the RANAS approach.
Have a closer look at our guideline about the Systematic Behavior Change approach.
You can download it on our webpage and go through it and
get more use to this kind of approach, thank you.
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